Chylothorax Following Celiac Plexus Block
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概要
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A case of chylothorax following a neurolytic celiac block is presented with review and discussion of the possible pathophysiology.A 51-year-old man with a history of chronic pancreatitis was referred to our Pain Clinic for celiac plexus block. Under image intensifier direction, in the prone position, 12-cm 22-gauge needles were placed 7cm lateral to the midline at the L-1 level and directed beneath the 12th ribs in a medial cephalad direction to rest anterior to the L-1 vertebral body; 10ml of 100% alcohol were injected on each side after negative aspiration tests. The patient had no pain relief in the right side, so four days later, the same directive technique was employed with addition of anatomic demarcation using 1ml of 10% lidocaine with 4ml iotrolan. Aspiration test was positive of milky fluid, hence we suspected the thoracic duct was penetrated. After changing needle position and injecting contrast solution, 10ml of 100% alcohol injected. X-ray films of the chest taken the day after the block revealed normal aeration of the lung field. The patient did well to had no immediate problems, obtained pain relief and was discharged from the hospital 7 days later. Thirty-two days after the last celiac block, he presented to the emergency room with chest pain, dyspnea, and a right pleural effusion on radiographic examination of the chest. Chest tube drainage was necessary to relieve symptoms, and 4, 500ml of chylous fluid was withdrawn during the next nine days. Chest tube drainage diminished daily.Our case report reinforces the need for follow-up of patients having such neurolytic celiac block and the need to include the relationships of the major lymphatic structures in anatomic descriptions of this particular procedure.
- 一般社団法人 日本ペインクリニック学会の論文
一般社団法人 日本ペインクリニック学会 | 論文
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