Acute and Critical Care

Thoracic Surgery
Chemical Pleurodesis Using Viscum album Extract in Gorham’s Disease Complicated with Chylothorax: Suk Ju Cho, Su Wan Kim; Acute Crit Care. 2018;33(2):105-109. Published online December 30, 2016; DOI: https://doi.org/10.4266/acc.2016.00164

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Gorham’s disease, also known as massive osteolysis, is characterized by unregulated proliferation of lymphatic or vascular capillaries within bone, resulting in destruction and replacement with angiomatous tissue. This disease can lead to chylothorax that can be lethal. Viscum album extract from European mistletoe is a complementary anti-cancer drug which is commonly prescribed in many European countries and is considered as a new generation of chemical agent for pleurodesis. A 14-year-old girl presented with dyspnea and chest pain. She was diagnosed as Gorham’s disease who was definitively treated with Viscum album extract for chylothorax that was refractory to standard conservative management.

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Systematic analysis of mistletoe prescriptions in clinical studies
Henrike Staupe, Judith Buentzel, Christian Keinki, Jens Buentzel, Jutta Huebner
Journal of Cancer Research and Clinical Oncology.2023; 149(9): 5559. CrossRef

Cardiology
Isolated Chylopericardium after Mitral Valve Replacement: the First Description of Adult Heart Disease in Korea: Su Wan Kim, Seogjae Lee; Korean J Crit Care Med. 2014;29(2):123-125. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.123

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Abstract PDF: Isolated chylopericardium as a complication of cardiac surgery is very rare. Two cases of chylopericardium have been previously reported in Korea; both patients suffered from chylopericardium after a corrective cardiac surgery for a congenital heart disease such as atrial or ventricular septal defect. We report a case of chylopericardium in a 55-year-old mitral valve replacement patient. The reason for chylopericardium was unclear, but it might have been related with the damaged lymph nodes and blunt dissection of the thymus. While most chylopericardium cases require surgical intervention, we managed this chylopericardium case with a low-fat diet for 3 days.

Chylopericardial Tamponade in a Patient with Chylothorax after Pulmonary Lobectomy: Jin Sue Jeon, Ho Geol Ryu, Hannah Lee, Da Hye Yoo; Korean J Crit Care Med. 2013;28(4):327-330.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.327

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Chylopericardium is a very rare, yet potentially fatal, complication following intrathoracic surgery, and can further lead to other life-threatening complications such as cardiac tamponade. A 54-year-old female underwent right upper lobectomy for lung cancer. Chylothorax developed on the 2nd postoperative day, and was managed conservatively with dietary modification. On the 9th postoperative day, the patient suddenly developed hypotension and severe cardiac dysfunction requiring cardiopulmonary resuscitation followed by VA ECMO. Transthoracic echocardiography revealed a large amount of pericardial effusion. Prompt pericardiocentesis was performed and the aspirated fluid showed features of chyle. Thoracic duct ligation with pericardial window operation was performed because the daily amount of chyle drained did not decrease after 3 weeks. Here, we review etiologies and therapeutic options of chylopericardial tamponade following intrathoracic surgery, which should not be underestimated even when the patient seems to demonstrate a good recovery.

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A Case of Chylopericardium Caused by Chylous Pleural Effusion Inflow from a Damaged Pericardium during Operation for Right Lung Cancer
Masahiro MATSUNO, Kyo HIRAYAMA, Nobuo TSUNOOKA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2023; 84(6): 868. CrossRef
A case of cardiac tamponade caused by chylopericardium after mediastinal lymph node dissection for recurrence of lung cancer
Shinsuke Kitazawa, Kojiro Nakaoka, Naohiro Kobayashi, Shinji Kikuchi, Yukinobu Goto, Yukio Sato
The Journal of the Japanese Association for Chest Surgery.2017; 31(2): 181. CrossRef
Isolated Chylopericardium after Mitral Valve Replacement: the First Description of Adult Heart Disease in Korea
Su Wan Kim, Seogjae Lee
Korean Journal of Critical Care Medicine.2014; 29(2): 123. CrossRef

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