History and clinical findings: One month after a coronary bypass grafting o
peration, pericardial- und pleural effusions were found in a 75-year-old wo
man. Dressler-syndrom was assumed and an antiphlogistic and cortisone were
prescribed. Under this therapy, the pericardial effusion disappeared, but t
he pleural effusion increased in size. After thoracocentesis, the diagnosis
of a chylothorax could be confirmed. Three days later, the thoracic radiog
raphy was inconspicuous and the patient was discharged without changes in m
edication. As dyspnea occurred two weeks later, the patient was admitted to
our hospital.
Investigations: The thoracic radiography showed a reappearance of the pleur
al effusion.
Diagnosis, therapy and course: The laboratory test confirmed a relapse of t
he chylothorax. After a pleurodesis by drainage and a prescription of a hig
h-caloric, fat-reduced diet the patient could be discharged two weeks later
. The diet could be terminated two months later after a recurrence of the c
hylothorax had been excluded in the thoracic radiography. In the follow-up
examinations, there was no evidence for a relapse of the chylothorax.
Conclusions: The chylothorax is an uncommon postoperative complication of t
he aortocoronary bypass surgery. A relapse is likely and it can result in l
ife-threatening cachexia. Therefore, a early and adequate therapy is import
ant.