An Uncommon Cause for a Preschool Child's Chronic Cough

Beverly P. Giordano, MS, RN, CPNP, PMHS; Sanjeev Y. Tuli, MD; Sonal S. Tuli, MD; Karin Reuter-Rice, PhD, CPNP-AC, FCCM; Terea Giannetta, DNP, RN, CPNP


J Pediatr Health Care. 2014;28(3):267-271. 

In This Article

Surgery and Postoperative Course

One month after she presented to the pediatric clinic with the chronic cough history, the child underwent dissection of the communication between the right arch and the descending thoracic aorta and resection of the left aortic arch. At the completion of the surgical procedure, there was a 2-cm separation between the two ends of the divided arch, and the esophagus was completely mobilized. The immediate postoperative course was uneventful, and she was discharged on the fourth postoperative day. Five weeks after surgery, erythema, tenderness, and purulent discharge developed from the lower aspect of the incision on the left side of the back. Cellulitis of the thoracotomy incision and a chylous left pleural effusion were diagnosed. She was admitted for 1 week of antibiotic therapy, chest tube drainage, and respiratory status monitoring, and a low-fat diet was initiated because of the chyle leak into the chest.

Two weeks later, the child presented to the pediatric nurse practitioner with left back and shoulder pain, which were the symptoms that prompted the previous admission for pleural effusion. A radiograph revealed reaccumulation of chyle in the left chest. The cardiologist subsequently managed the child as an outpatient with daily furosemide, and the low-fat diet was continued. A follow-up chest radiograph 2 weeks later demonstrated resolution of the pleural effusion.