PMC6452529_01
AP chest radiograph of the patient in the ED illustrating bilateral left greater than right chylous pleural effusions upon initial presentation.
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A chest radiograph was obtained, showing moderate bilateral pleural effusions that had reaccumulated over the past week since his last thoracentesis (Figure 1).
A transthoracic echocardiogram illustrating an apical four-chamber view of the patient's heart during diastole illustrating right ventricular free wall collapse.
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Cardiology while still in the ED and a STAT transthoracic echo was performed (Figure 2) showing compression of the right atrium and right ventricle during diastole. Cardiothoracic surgery was immediately consulted and the patient was taken for an emergent pericardial window.
The patient's left chest tube with 1950cc of fluid drainage. You can clearly see the pleural fluid transitioning from pure chylous to almost completely serous.
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Octreotide 100mcg every 8 hours subcutaneously. Overnight to the morning of postoperative day (POD) 1, the patient drained another 1.9L of chylous fluid from the left chest tube (Figure 3) and 1L from the right chest tube.