Post- Intercostal Intubation Chylothorax

Abstract Chylothorax is a rare condition in childhood . It usually occurs as a post operative complication followingcardiac surgery for heart diseases . we report a 16 months old girl with atrial septal defect and severepulmonary stenosis, hospitalised for empyema and who developed chylothorax following intercostal drainage,an entity which has never been reported. Key Words Chylothorax, Medium chain triglycerides, Intercostal drainage Introduction Chylothorax generally occurs as a post thoracotomycomplication during management of congenital cardiaclesions . However rarely it can occur due to malformationof the pulmonary or thoracic lymphatic systems (1-2).The consequences of chylothorax include fluid andelectrolyte disturbances, protein calorie malnutrition,coagulopathy and increased susceptibility to infections(3). An interesting case of chylothorax in a 16 monthsold child with congenital heart disease as a complicationof intercostal drainage is discussed. Case Report A16 months old girl , a known case of otiumsecundum atrial septal defect and severe valvularpulmonary stenosis presented with high grade fever, poor feeding and breathlessness for one week forwhich she had received oral antibiotics.Examination revealed a toxic , febrile andmalnourished child with evidence of pleural effusionon the left side. The pleural tap revealed a thickpurulent exudate (protein content of 6.2 gms% andnumerous WBCs/HPF with 75% polymorphs andstaining revealed Gram positive cocci ) She wasmanaged with parenteral antibiotics and intercostaldrainage . The intercostal tube drained 500 ml offrank yellow pus on day one which gradually reducedto 50 ml on third day. She became afebrile afterthree days but on the fourth day , the drainage fluidwas observed to be thin ,copious , milky white and itsvolume increased to 700-800 ml/day. A clinicaldiagnosis of chylothorax was now made and confirmedby reanalysing the fluid : proteins 4.5gms% ,triglycerides 1255gms% and lymphocyticpredominance. CT chest showed normal vascularstructures , lung parenchyma and did not reveal anymediastinal or hilar lymphadenopathy.Lymphangiography could not be done as the facilitiesfor same were not available . Child was managedwith medium chain triglyceride enriched milk . Theamount of fluid drained decreased after seven days,intercostal tube was taken out on 15th day ofadmission and she was discharged after 35 days ofhospitalisation .A follow up after six weeks revealedstatus quo.