Hemothorax and chylothorax in children
Navaei .Safoura.MD,Assistant Professor of Pediatric Pulmonology,Children’s Medical Center, Tehran University of Medical Science
Hemothorax is the presence of blood in the pleural space. The source of blood may be the chest wall, lung parenchyma, heart, or great vessels. Hemothorax is usually a consequence of blunt or penetrating trauma. Much less commonly, it may be a complication of disease, may be iatrogenic ally induced, or may develop spontaneously.
Therefore hemothorax should be considered in all cases of blunt and penetrating chest trauma in children. Hemothoraces can also be iatrogenic, occurring after chest drain insertion, intrathoracic surgery, or with inappropriate placement of central lines. Hemothoraces can cause significant cardiorespiratory effects, including cardiac arrest, and can be complicated by secondary infection and fibrosis, causing “trapped lung,” although these complications appear to be less frequent than the rates seen in adult patients with hemothorax. Hemothorax can be diagnosed on CXR or in the setting of trauma. A focused assessment with sonography for trauma (FAST) ultrasound scan may be considered and may be more sensitive than CXR.Treatment will depend on the nature of the injury (either penetrating or blunt force), size of the hemothorax, and clinical status of the patient. Some pediatric patients with hemothorax can be managed conservatively with close observation. Others, particularly those with penetrating chest injuries or large hemothoraces, will require tube thoracostomies or open thoracic surgery to stop the bleeding.
Chylothorax : Chylothorax is a rare condition in which lymphatic fluid leaks into the space between the lung and chest wall. When this fluid builds up in the lungs, it can cause a severe cough, chest pain and difficulty breathing. Injury to the thoracic duct (the main lymph vessel), congenital abnormalities or excessively high venous pressures can result in lymphatic flow problems and leakage of lymphatic fluid into the chest, abdomen or other body cavities.The use of an MCT diet coupled with avoidance of long-chain fatty acids reduces lymph flow because MCT is absorbed directly into the portal system and contributes little to chylomicron formation. Generally, chylous effusion ceases by the end of the second week of treatment. A trial of fasting and parenteral hyper alimentation is indicated for patients in whom chyle reaccumulates rapidly. Conservative treatment should be continued for4 to5 weeks to allow closure of lymphatic channel fistulae. Rarely, a chylothorax is due to lymphangiomyomatosis and does not respond to dietary manipulation