Chylous Leakage After Thoracolumbar Fracture May Cause Paraplegia
| Autor: | Marius von Knoch, Stefan Mueller, Leila Siahkamary, Ivo Michiels |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Reoperation
Chylous leakage medicine.medical_specialty Fistula Pathologic fracture Thoracic Vertebrae Thoracic duct Thoracic Duct Diagnosis Differential Iodine Radioisotopes medicine Humans Orthopedics and Sports Medicine Spinal canal Radionuclide Imaging Retrospective Studies Paraplegia Lumbar Vertebrae business.industry Chyle Middle Aged Decompression Surgical medicine.disease Magnetic Resonance Imaging Surgery Fractures Spontaneous medicine.anatomical_structure Lymphatic system Drainage Osteoporosis Spinal Fractures Female Neurology (clinical) Differential diagnosis business |
| Zdroj: | Spine. 29:E32-E34 |
| ISSN: | 0362-2436 |
| DOI: | 10.1097/01.brs.0000105982.30754.09 |
| Popis: | STUDY DESIGN Retrospective case report. PURPOSE This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement. BACKGROUND INFORMATION This clinical presentation of chylous leakage has not been reported previously. RESULTS A 61-year-old female with osteoporosis suffered a pathologic fracture of the vertebral bodies T12 and L1 and developed partial paraplegia two weeks later. Imaging showed expansive pooling of intraspinal fluid without intrathoracic or retroperitoneal involvement. A blood-tinged fluid was aspirated from dorsal. Repeated surgery by a posterior approach with drainage of the fluid did not improve the patient's condition, so she was finally transferred to our hospital. Under the suspected diagnosis of lymphatic leakage a scintiscan with 123I-iodinephenylpentadekanacid-marked cream verified the presumption of a lymph fistula at the level of T12/L1, originating from the thoracic duct. By permanent draining of the posterior fistula without suction and strict intravenous alimentation the fluid production decreased continuously and finally ceased completely. Simultaneously, the neurologic state improved gradually without returning to normal completely. CONCLUSIONS This case demonstrates that paraplegia can develop due to chylous leakage into the spinal canal without obvious retroperitoneal or intrathoracic involvement. This differential diagnosis should be kept in mind when treating patients with abundant fluid drainage into or from the spinal canal. |
| Databáze: | OpenAIRE |
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