PMC6378334_01
Perioperative course of the patient. Spinal surgery was performed in 2 stages; on day 1 and day 14 of hospitalization, and postoperative albumin levels showed a transient decrease on both operation days. X-ray on day 24 (to assess bone condition) showed blunting of the costophrenic angle, which was not seen before surgery. Right pleural effusion was showed on magnetic resonance imaging on day 46 of hospitalization. OLIF: oblique lateral interbody fusion PS: pedicle screw PLIF: posterior lumbar interbody fusion.
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Two weeks after the first operation, she underwent pedicle screw placement for Th8 to S2 and posterior lumbar interbody fusion for L3 to L5 (Fig. 1).
Chest X-ray at the time of hospitalization. The right costophrenic angle was dull (A). There was no lung parenchyma abnormalities or lymph node enlargement, but right pleural effusion was showed on chest CT (B).
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Chest X-ray and computed tomography (CT) showed only right pleural effusion, and lung parenchyma abnormalities and lymph node enlargement were not observed (Fig. 2).
Right thoracentesis solution. The pleural effusion sample was pinkish white.
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The color of the thoracentesis sample was pinkish white (Fig. 3), and the Triglyceride (TG) level in the pleural effusion was high (852 mg/dL).
Lymphatic scintigraphy. A hot spot was identified in the right thoracic cavity near the screw in the Th11 slice (red arrows). Black circles indicate the position of the screw.
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TG level (62 mg/dL) and Total cholesterol level (<57.0 mg/dL) in the pleural effusion both showed lower levels than the TG level in the pleural effusion, the pleural effusion was concluded to be a result of chylothorax. The point of leakage from the lymph duct could not be identified by lymphography, but fluid accumulation was confirmed in the right thoracic cavity of the slice that corresponded to that with the screw at Th11 by lymphatic scintigraphy (Fig. 4); therefore, we considered this to be the point of leakage of the lymph fluid.
Patient's clinical course after admission. Albumin levels and the amount of pleural effusion appear to be inversely correlated. Albumin levels and the amount of pleural effusion were improved after starting the fat-restricted diet and octreotide treatment. TPN: total parenteral nutrition.
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The patient's pleural effusion decreased gradually, her albumin level and leg edema improved, and hence her fat restriction was discontinued and the patient was discharged (Fig. 5).