weekly_question 5/6/2022

[Admin]

A one week-old, term infant develops tachypnea and hypoxemia with bilateral pleural effusions. Bilateral chest tubes are placed with drainage of approximately 30 ml/kg/day of fluid with 91% lymphocytes. The patient is treated with one week of bowel rest and total parenteral nutrition. This is followed by two weeks of octreotide infusion (up to 6 mcg/kg/hour). The chest tube output has not changed. The best next step is:

A Increase octreotide infusion to 12 mcg/kg/hour

B Instillation of bleomycin into the pleural spaces

C Thoracic duct ligation and bleomycin instillation into the pleural spaces

D Thoracic duct ligation and mechanical pleurodesis

E Thoracic duct ligation, pleurectomy and mechanical pleurodesis

[Admin]

correct answer
E Thoracic duct ligation, pleurectomy and mechanical pleurodesis

Severe congenital chlyothorax is a potentially lethal condition that requires careful management. In a term infant, a step-up approach of bowel rest and total parenteral nutrition (TPN) followed by octreotide infusion is reasonable. If there is no improvement after reaching the maximum dose of 6 mcg/kg/hour, then the patient should be brought to the operating room for thoracic duct ligation and pleurectomy. Other surgical options, such as chemical pleurodesis and/or thoracic duct ligation alone may be appropriate in patients with chylothorax due to thoracic duct injuries but are less effective in cases of congenital chylothorax. Furthermore, thoracic duct ligation, pleurectomy and pleurodesis is more effective than thoracic duct ligation and mechanical pleurodesis alone.

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C

[Pedsurgkb]

None of the above. Thoracic duct embolization

[Radwan suleiman abukarsh]

C

[Admin]

correct answer
E Thoracic duct ligation, pleurectomy and mechanical pleurodesis

Severe congenital chlyothorax is a potentially lethal condition that requires careful management. In a term infant, a step-up approach of bowel rest and total parenteral nutrition (TPN) followed by octreotide infusion is reasonable. If there is no improvement after reaching the maximum dose of 6 mcg/kg/hour, then the patient should be brought to the operating room for thoracic duct ligation and pleurectomy. Other surgical options, such as chemical pleurodesis and/or thoracic duct ligation alone may be appropriate in patients with chylothorax due to thoracic duct injuries but are less effective in cases of congenital chylothorax. Furthermore, thoracic duct ligation, pleurectomy and pleurodesis is more effective than thoracic duct ligation and mechanical pleurodesis alone.