Chylothorax associated with subcutaneous cellulitis caused by chylous fluid leakage in a dog
Vieira, Raphael SimõesMota, Francisco Cláudio DantasBorin-Crivellenti, SofiaOblak, Michelle
Background: Chylothorax is the accumulation of lymphatic fluid associated with molecules coming from digestion process(chyle) in the thorax. In this case report, we describe a canine patient with chylothorax that presented with an unusualclinical presentation: subcutaneous swelling due to chylous fluid leakage through the thoracic inlet.Case: A 4-year-old spayed female canine, Giant Schnauzer, presented to the Ontario Veterinary College Health SciencesCentre for evaluation and treatment of bilateral subcutaneous masses and edema on the ventral thorax. The patient wasoriginally evaluated by the primary care veterinarian and aspiration and cytology of the masses resulted in a large volumeof fluid with low cellularity, lightly basophilic. Due to the appearance of the fluid, triglyceride levels were performed andwas 7.95 mmol/L while the peripheral level was 0.5 mmol/L (ref: 0.2-1.3 mmol/L). Based on the cytology and triglyceridelevels, chylous fluid was suspected to be the cause of the swelling and edema. Over the following 10 months, the swellingprogressed to bilateral tumors of approximately 15 cm in the lateral thorax and surrounding edematous tissues on the ventralthorax. The patient was referred for evaluation. On presentation the patient was normal aside from the described thoracicswellings and decreased lung sounds on auscultation. Thoracic ultrasound revealed bilateral pleural effusion. Thoracentesisresulted in approximately 1,200 mL of chylous fluid. Thoracic computed tomography (CT) and lymphangiography throughpopliteal injection revealed bilaterally in the soft tissues of the axillary regions, and extending along the right thoracic wall,a moderate amount of fluid dense material. The lymphangiogram revealed two sites of rupture of lymphatic vessels, inthe caudal thorax (right sided), and in the cranial mediastinum/right thoracic inlet. Based on the findings, a video-assistedthoracic duct ligation and cisterna chyli ablation were...(AU)
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