Experta??s Comment concerning Grand Rounds case entitled a??Chyluria and chylothorax after posterior selective fusion for adolescent idiopathic scoliosisa?? by A.A. Weening et al. Eur Spine J; DOI 10.1007/s00586-017-5066-y

摘要

This is a well-written case report presenting an interesting and complex problem of postoperative chylothorax and chyluria [1]. In my comments as thoracic surgeon I would concentrate on the difficult problem of chylothorax, which is the condition caused by the injury of thoracic duct. The anatomy of the thoracic duct is constant only in its variability and is considered to be normal only in about 65% of humans. The duct usually crosses the chest behind the aortic arch into the left posterior mediastinum at the level of Th6-Th5. The injury to the duct above this level usually causes the left chylothorax; however, in practice we face much more common the right chylothorax caused by the injury to the duct below this level. There are many classifications of chylothorax. The basic and very practical classified chylothorax as congenital, postoperative traumatic, non-surgical traumatic and non traumatic, where the ethiology varies depending on geography, which is discussed in this case report.