Chilotoraxys

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Chilotoraxys is a type of pleural effusion resulting from an accumulation of lymphatic fluid in the pleural cavity. The cause is usually leakage from the thoracic duct or one of the main lymphatic vessels that drain into it.
The most common causes are lymphoma and trauma caused by thoracic surgery. If the patient has a normal diet, pleurisy is identified by appearance or white milk contains high levels of triglycerides. A fracture in the thoracic duct determines the collection of fluid in the pleural cavity causing chili chronic or acute deterioration of lung mechanics. In normal adult thoracic duct trsnsporta to 4 liters of lymph per day and allowing rapid accumulation of large amount of fluid in the chest.
The patient usually remains asymptomatic until it accumulates a large amount of fluid in the pleural space. Symptoms include dyspnea, tachycardia, pain in the affected hemitoracele. Rarely patients may experience a rapid accumulation of fluid in the pleural space causing a tension chilotorax. It is usually a complication of pneumectomiei. Patients have similar hemodynamic and respiratory compromise in tension pneumothorax.
Once the mechanism is not well known back chilotoraxului therapeutic options are limited. Fluid in the pleural space drainage is essential to prevent organ damage, especially liver function by inhibition of fluid backpressure. Omitting fat diet is essential. Pleurodeza are surgical or chemical treatment options. Liquid flow is stopped by irritating the lungs and chest wall with pleural inflammation and closed space. Medication with octreotide proved beneficial and in some cases chilotoraxul stopped after a few weeks.
Anatomy and Physiology: Thoracic or thoracic duct is the main collector channel that carries lymph from the lymphatic tissues to the venous system thus fulfilling an essential fucntie body homeostasis. Despite this fact of anatomy and physiology is poorly understood. The intercellular space was added to the interstitial fluid chemically similar to a plasma that is formed by ultra filtration of capillary and arteriolar segment continuously absorbs the venular segment. Absorption capacity is however limited and a quantity of 1 / 10 of this fluid is removed from this level through the lymphatic system in the form of lymph. We can say that the lymphatic system is a special segment of the circulatory system accounted for circulating fluid-lymph and lymph vessels. This differs from the vascular system itself because it forms a closed loop.
Risk factors and causes: Congenital Chilotorax: Chile poured serous cavities can occur either as a result of duct malformations (aplasia, hypoplasia, atresia, cyst) or Pequet tank as well as a result of birth trauma and central venous pressure increased during labor. Malformations outside the tank can lead to overload chiloperitoneu by chilotorax or chilopericard. Other causes defects that can cause lymph extravasation were defects in the ductal walls: lymphangioma, limfangiectazie, limfangiomatoza, lymphatic dysplasia syndrome, and multiple dilated lymphatic channels with pleural fistula. Congenital lesions of the lymphatic system is the most common cause of pleural effusion in the newborn. Chilotorax traumatic: In major trauma with injuries of the upper abdomen, thoracic and cervical region, thoracic duct may be injured due to the anatomical relationship you have with vertebral corpus. The most common site of injury is at T4-5 vertebral body. In closed tear duct injuries can occur through different pathogenic mechanisms: hyperextension of the spine especially when the duct is fixed by the pathological process and is full-postprandial-rupture occurs above the diaphragm; effort vomiting, coughing and sneezing violently access may lead to chiloperitoneului chilotoraxului appearance or shearing by thoracic duct as a pillar of the diaphragm, cervical contusion hiperpresiune retrograde forces can result in duct rupture followed by, repeated chest trauma. In open injuries, gunshot wounds are often white or weapon because of damage to the thoracic duct. The lesion is overshadowed by damage to other vital structures.
Preoperative radiotherapy in iatrogenic injuries are risk factors for thoracic duct injury induced by local fibrosis. Both surgeries as well as specific cardiovascular thoracic surgery may be followed by thoracic duct fistula: ligation of the ductus arteriosus, coarctation of the aorta cure, anvrism aortic resection, Fontan operation, Mustard, by-pass aorto-coronary esophagectomy , thymectomy. Chilotoraxul neoplastic Malignant and benign obstructive lesions-latero-cervical lymph nodes, supraclavicular, neighborhood tumors, infections, specific and nonspecific thoracic duct may be interesting stick. Malignant obstructive lesions, limfoangiosarcom, benign tumors of the neighborhood, have been associated with tuberculosis chilotoraxul. If damage lymphatic malignancies may be unilateral or bilateral with the following mechanisms: compression deterinata tumor, adenopathy, tumor invasion by tumor embolism. Hiperpreziune or erosion can result duct, followed by flushing of lymph in the pleural cavity.
Other causes of nephrotic syndrome can be chilotorax (colloid osmotic pressure decrease protein loss leading to increased production of lymph fluid), diabetes (glucose transport is limited by capillary permeability so that more carbohydrate molecules reach the interstitial space with increasing pressure-colloid osmotic).
Pathogenesis: The main causes of fistula Chile are effusion thoracic duct obstruction at different levels or channel its repercussions on waging tributarelor pathophysiological mechanisms depending on the level where it appears. Thoracic canal obstruction with increased water pressure over 50 cm will lead to either tear duct or its tributarelor or lymph extravasation at serosal interstitial tissue, by increasing the pressure or the appearance of small lymphatic vessels chilotoraxului, chilopericardului, or chiloperitoneului limfedemelor. Gravity keel effusions occurring in the thoracic duct obliteration is lower than those incurred by its fistulization.
Due to the lecithin, fatty aciizi Chile has bacteriostatic properties, are usually sterile. Unlike pleural effusion, Chile pahipleurita not cause irritation, also has the tendency to fistulization cloazonare or chest wall. But like other filling pleural effusion by pleural space will lead to adverse respiratory chilotoraxul cardiocirculatorii. Because the role of nutrition in immunity and its loss will have serious repercussions of these points of view. Determinatre physiological phenomena are lost and the amount of liquid flow.
In chilotoraxul progressive installation can cause physiological disorders by: pulmonary compression, pulmonary collapse, leading to decreased ventilation and perfusion and subsequently with hypoxemia by rights-are left, contralateral mediastinal shift with respiratory failure, decreased venous return with mental cardiocirculatorii , caused by loss of protein metabolism, and fat-soluble vitamins, which can lead to malnutrition in advanced stages and death, immunological disorders result of the loss of lymphocytes and antibodies with increased risk of severe infections.
There are situations when accumulation is fast when cardiorespiratory phenomena and not dominate the metabolic or immunologic. Appears dyspnea with tachypnea, tachycardia, hypotension and shock occurs rapidly.