[Chylothorax as a postoperative complication of aortocoronary bypass operation].

HISTORY AND CLINICAL FINDINGS: One month after a coronary bypass grafting operation, pericardial- und pleural effusions were found in a 75-year-old woman. Dressler-syndrome was assumed and an antiphlogistic and cortisone were prescribed. Under this therapy, the pericardial effusion disappeared, but the pleural effusion increased in size. After thoracocentesis, the diagnosis of a chylothorax could be confirmed. Three days later, the thoracic radiography was inconspicuous and the patient was discharged without changes in medication. As dyspnea occurred two weeks later, the patient was admitted to our hospital.

INVESTIGATIONS: The thoracic radiography showed a reappearance of the pleural effusion.

DIAGNOSIS, THERAPY AND COURSE: The laboratory test confirmed a relapse of the chylothorax. After a pleurodesis by drainage and a prescription of a high-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 chylothorax 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 the aortocoronary bypass surgery. A relapse is likely and it can result in life-threatening cachexia. Therefore, a early and adequate therapy is important.