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Involvement of fatty tissue planes in supra and infraclavicular region with diffuse hypodensity where distribution was suggestive of lymphatic duct lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical Case</span><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a patient aged 51 with a medical history of high blood pressure, diabetes mellitus type 2 and OSAS, who presented at the emergency department with a sudden increase in left cervical and supraclavicular volume, mildly painful to the touch which started when resting due to predominantly right sided nagging lumbar pain. The patient did not present with signs of systemic inflammatory response, nor dyspnoea, dysphonia or dysphagia. On examination a slightly painful left supraclavicular mass was found. It was not mobile, nor crackling, nor pounding and there were no changes to the skin. Endoscopy, laryngoscopy and pharygoscopy resulted normal. Laboratory analysis reported leukocytosis of 14<span class="elsevierStyleHsp" style=""></span>690 with 82% neutrophil which normalised in the control analysis after 12<span class="elsevierStyleHsp" style=""></span>h, and proteinanaemia of 7.8<span class="elsevierStyleHsp" style=""></span>g/dl. CT of the neck showed involvement of fatty issue planes in the supra and infraclavicular region with hypodensity of diffuse distribution where the distribution was highly suggestive of a lymphatic duct lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The contrast enhanced control CT after 24<span class="elsevierStyleHsp" style=""></span>h showed a reduction in cervical fatty tissue plane occupation (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Clinical and radiological evolution showed progressive remission with conservative therapy, observation and intravenous support, and no other therapy was therefore required.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">The thoracic duct is the largest lymph vessel in the body and drains approximately 75% of the lymph fluid, extending from the cisterna chyli to the left jugular vein angle. It rises to the right of the aorta and is anterior to the vertebral column. It continues its course between the aorta and the azygos vein, entering the thorax through the aortic hiatus.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1–3</span></a> Thoracic duct lesion produces chylothorax and this is associated with mortality rates of 50% due to the loss of plasma proteins, fat-soluble vitamins, triglycerides, lymphocytes, electrolytes and intravascular volume. The main mechanisms of thoracic duct lesion include: (1) direct trauma of lymph vessels, and (2) occlusion of thoracic duct, with posterior development of unstable side effects. The most common lesion is caused by trauma, which may be iatrogenic, including thoracic surgery; cardiac; head and neck with the most common being in oesophageal resection with a 4% incidence.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cyle fistulas have been reported as the result of venous hypertension, in patients with superior cava vena syndrome.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Non occlusion and leakage of the thoracic duct are less common and may derive from malignant aetiologies such as lymphomas, oesophageal carcinomas, lung tumours or intrathoracic metastasis. They may also arise from benign aetiologies including systemic inflammatory or infectious diseases, primary diseases of the lymph vessel or from idiopathic causes responsible for the majority of chylothorax aetiologies.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The lesion of a lymphatic vessel is common after physical or surgical trauma but the damaged lymphatic vessels cure themselves spontaneously thanks to drainage which filters through collateral vessels without major morbidity.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Different imaging techniques are available for diagnosis, although the lymphangiogram is the gold standard for the study of the thoracic duct. Nuclear magnetic resonance does not provide sufficient detail for diagnosis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Many conservative treatments have been described in the initial phase, from observation and monitoring in asymptomatic patients to fine needle aspiration or the injection of sclerosants. Notwithstanding, their efficacy is limited.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Conservative treatment is contraindicated when the output per fistula is higher than 600<span class="elsevierStyleHsp" style=""></span>ml/day or 500<span class="elsevierStyleHsp" style=""></span>ml/day for 5 consecutive days, when in spite of treatment the output per fistula does not diminish or when there are metabolic and/or nutritional complications. In these cases the treatment of choice is surgery using embolisation or ligature of the thoracic duct.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our case the only clinical symptom the patient presented with was increased laterocervical volume and they had no history of any iatrogenic or external trauma. Moreover, they had not suffered from any clinical history of venous hypertension or primary disease of the lymphatic system or any previous systemic diseases, and aetiology was therefore determined as idiopathic when other possible triggers were rejected. Laboratory studies tested normal and no metabolic or nutritional changes occurred. The CT cervical scan confirmed our diagnosis of a thoracic duct lesion, with no other diagnostic possibilities and the patient was therefore not referred for other imaging tests. The patient evolved favourably with conservative treatments, monitoring and observation and no other invasive treatment was administered.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Cervical thoracic duct lesion is a rare entity, the presence of which is associated with external traumas or cervical surgery.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It may cause mild malaise in the patient or secondary complications and may include nutritional or immunological deficiencies which may even put the patient's life at risk.</p><p id="par0050" class="elsevierStylePara elsevierViewall">CT provided us with probable diagnosis and an accurate diagnosis came through evolution.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Spontaneous resolution of the process justified non performance of invasive therapies.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of Interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical Case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conclusion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of Interests" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-03-09" "fechaAceptado" => "2017-05-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodriguez N, Navarrete ML, Ortiz C, Dyer S. Lesión del conducto torácico a nivel cervical de forma espontánea: a propósito de un caso. Acta Otorrinolaringol Esp. 2018;69:178–180.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 772 "Ancho" => 1667 "Tamanyo" => 136310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cervical CT: axial and coronal slice. Involvement of fatty tissue planes in supra and infraclavicular region with diffuse hypodensity where distribution was suggestive of lymphatic duct lesion.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 738 "Ancho" => 1667 "Tamanyo" => 122468 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cervical CT: axial and coronal control slice after 24<span class="elsevierStyleHsp" style=""></span>h evolution. 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Journal Information
Vol. 69. Issue 3.
Pages 178-180 (May - June 2018)
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Vol. 69. Issue 3.
Pages 178-180 (May - June 2018)
Case Study
Spontaneous Rupture of Cervical Thoracic Duct: A Case Report
Lesión del conducto torácico a nivel cervical de forma espontánea: a propósito de un caso
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