Çocukluk Çağında Şilotoraks; Üç Olgu Sunumu, Güncel Tanı ve Tedavi Yaklaşımları

Year 2015, Volume: 9 Issue: 3, 219 - 225, 01.08.2015

Yakup Canıtez Şükrü Çekiç Arif Gürpınar Nihat Sapan

Abstract

Şilotoraks, çocukluk çağında plevral efüzyonun nadir bir nedenidir. Hastalığın etiyolojisi yaşa göre değişmekle birlikte, başlıca nedenler; konjenital nedenler, cerrahi işlemler, travma, tümöral nedenler, idiyopatik ve bazı enfeksiyöz hastalıkları olarak bildirilmektedir. Klinik bulgular, radyolojik bulgular ve plevral sıvının analiziyle şilotoraks tanısı konulan üç çocuk olgu; iki buçuk aylık kız hasta (idiyopatik “non-immun” hidrops fetalis ilişkili konjenital şilotoraks), üç buçuk aylık erkek hasta (idiyopatik şilotoraks) ve on bir aylık erkek hasta (idiyopatik şilotoraks) sunuldu. Hastaların üçü de toraks tüpü ile drenaja ek olarak medikal tedavi (Olgu 1; total parenteral nutrisyon ve orta zincirli yağ asiti içeren formul mama, Olgu 2; total parenteral nutrisyon, orta zincirli yağ asiti içeren formul mama ve somatostatin, Olgu 3; orta zincirli yağ asiti içeren formul mama) ile tedavi edildi. Her üç olguda da tedavi sonrası izlem dönemlerinde nüks görülmedi. Şilotoraks tanısı klinik bulgular, radyoloji ve plevral sıvının analizi ile konulmaktadır. Diyet ve total parenteral nutrisyon tedavilerine yanıt alınamayan olgularda somatostatin veya oktreotid tedavisinin eklenmesiyle ile iyi sonuç alınabilmektedir. Medikal tedaviye dirençli olgularda cerrahi tedavi uygulanabilmektedir.

Keywords

Çocuk, Oktreotid, Plevral efüzyon, Somatostatin, Şilotoraks

Chylothorax in Childhood; Three Case Reports with Current Diagnosis and Treatment Approaches

Abstract

Chylothorax is a rare cause of pleural effusion in childhood. Even though the etiology of the illness varies according to age, the major causes have been reported to be congenital causes, surgical procedures, trauma, tumoral factors, idiopathic and some infectious diseases. The three pediatric cases diagnosed as chylothorax with the help of clinical and radiological findings and pleural fluid analysis presented here include a 2.5-month-old female patient (idiopathic non-immune hydrops fetalis-associated congenital chylothorax), a 3.5-month-old male patient (idiopathic chylothorax) and an 11-month old male patient (idiopathic chylothorax). All three patients recovered with medical treatment (case 1; total parenteral nutrition and formula containing medium-chain fatty acids; case 2; total parenteral nutrition and formula containing medium chain fatty acids and somatostatin; case 3; formula containing medium chain fatty acids) supplemented by chest tube drainage. No recurrence was observed in any of the cases during the follow-up period. The diagnosis of chylothorax is made through clinical findings, radiology and the analysis of pleural fluid. In cases that fail to respond to treatment with diet and total parenteral nutrition, a successful outcome can be possible with the addition of somatostatin or octreotide treatment. Surgical treatment can be used in cases resistant to medical treatment

Keywords

Child, Octreotide, Pleural effusion, Somatostatin, Chylothorax

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