Mediastinal lymphangioma accompanied with bilateral chylothorax

Abstract

We report a case of a mediastinal lymphangioma accompanied with bilateral refractory chylothorax. A 53-year-old woman was admitted to our hospital for progressive dyspnea. Computed tomography (CT) of the chest revealed a mass measuring 4 cm in diameter in the right lower anterior mediastinum. Because of progressive dyspnea and a cough, thoracentesis was performed and the presence of a milky fluid was confirmed. The chylothorax was drained with a catheter, and daily drainage persisted at over 500ml. Complete resection of the anterior mediastinum mass and thoracic duct ligation were performed through a right thoracotomy. Histological examination diagnosed the tumor as benign lymphangioma. Postoperatively, with the persistence of chyle drainage greater than 1000ml per day, a second surgical intervention was undertaken on the 16th day after the first operation. After the second surgery, however, the patient continued to drain chylous discharge, and needed further chemical pleurodosis. On the 40th day after the first surgery, the patient developed left chylothorax too, and needed drainage tube insertion and chemical pleurodosis. The right and left chest tubes were removed on the 54th and 96th day after the first surgery, respectively. A 14-month follow-up period showed the patient to be in excellent health with no detectable signs of pleural effusion on chest roentgenogram.