CHEST Guidelines-A-Case-of-Lymphangiomatosis-With-Infected-Lymphang

A-Case-of-Lymphangiomatosis-With-Infected-Lymphang

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This document reports on a medical case involving a 40-year-old woman diagnosed with lymphangiomatosis experiencing an infected intrathoracic lymphangioma. Presenting with a high fever and a previously known condition since age 8, the patient exhibited high WBC count and elevated C-reactive protein, indicative of infection, specifically testing positive for Staphylococcus aureus. Initial attempts to treat the infection included inserting a chest tube to drain the cyst and administrating the antibacterial drug cefazolin. However, due to the high viscosity of the effusion and intralymphatic septa, drainage was ineffective.<br /><br />To address these challenges, a thoracoscopic debridement coupled with a pulsed-lavage system was performed. This minimally invasive surgical method allowed for the removal of viscous effusion and fibrin membranes acting as septa under general anesthesia. The surgery resulted in immediate clinical improvement, with reduced cyst size and reexpansion of the lung as confirmed by postoperative CT images. The patient showed recovery with normalizing WBC levels and negative drainage cultures ultimately leading to discharge on the ninth postoperative day. Two months following the surgery, CT imaging reflected reduced cyst size and maintained lung structure, with the patient's condition remaining stable for two subsequent years.<br /><br />Lymphangiomatosis is characterized by the presence of scattered lymphangiomas across multiple organs, often leading to complications such as pleural effusion or chylothorax. This case emphasizes the effectiveness of thoracoscopic surgery for infected lymphangiomas, offering a reliable treatment alternative to traditional drainage and antibiotics, particularly in cases complicated by infection and structural barriers within cysts.

Keywords

lymphangiomatosis

infected lymphangioma

thoracoscopic debridement

Staphylococcus aureus

chest tube drainage

cefazolin

pulsed-lavage system

minimally invasive surgery

pleural effusion

chylothorax