[Pubmed] Double trouble following VATS thymectomy for thymoma: an unusual complication and new-onset myasthenia gravis i

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Indian J Thorac Cardiovasc Surg. 2026 Aug;42(8):994-999. doi: 10.1007/s12055-025-02145-w. Epub 2026 Mar 4.

ABSTRACT

We present a case of a 38-year-old lady who developed chylothorax following video-assisted extended thymectomy and post-thymectomy myasthenia gravis (PTMG). The patient had non-myasthenic thymoma and underwent video-assisted thoracoscopic surgery (VATS) extended thymectomy. On the second postoperative day (POD), we noticed milky fluid from the intercostal drain. On subsequent biochemical analysis, a diagnosis of chylothorax was confirmed. She was managed successfully with conservative measures, including dietary modification. She was discharged on postoperative day 10. Three months following VATS thymectomy, she presented in myasthenic crisis, corresponding to Myasthenia Gravis Foundation of America (MGFA) Class V. With a diagnosis of PTMG, she was admitted to the intensive care unit for further management. Pharmacological management, including intravenous (IV) corticosteroids, azathioprine, and pyridostigmine along with plasma exchange (PLEX) therapy, was initiated. Respiratory support was provided via bilevel positive airway pressure (BiPAP) for non-invasive ventilation. Chylothorax is a rare complication of thymectomy; only 13 cases have been reported in English literature to date. This case highlights the importance of early recognition and non-operative management strategies in addressing this uncommon postoperative entity while also drawing attention to the potential for PTMG. This case is exceptionally rare, as it represents the first documented case in the English literature of a patient without preoperative myasthenia gravis (MG) who developed both chylothorax and post-thymectomy myasthenic crisis following VATS thymectomy. This report highlights the uniqueness and clinical significance of this presentation.

PMID:42454169 | PMC:PMC13365106 | DOI:10.1007/s12055-025-02145-w


Source: https://pubmed.ncbi.nlm.nih.gov/4245416 ... 1&v=2.20.0