With increasing experience with endovascular techniques in the adult
population, selected cases of thoracic aortic injury in children have been
successfully treated with endovascular stents. Thoracic endovascular aortic
repair (TEVAR) is currently investigational and has been performed in cases
where severe concomitant injuries preclude open repair. Concerns regarding
the use of TEVAR in the pediatric population include complications associated
with growth of the aorta around a fixed sized stent and long-term durability of
the stent in young children with a long life expectancy. Although TEVAR is an
attractive alternative and less invasive procedure for aortic repair, little is known
about the long-term outcomes in children. Thus, surgery is the mainstay of
therapy unless otherwise contraindicated.
K. Traumatic Chylothorax
Non-iatrogenic traumatic chylothorax is extremely rare in children with
only sporadic case reports of chylothorax occurring in children after blunt
trauma. The thoracic duct is the main vessel of the lymphatic system that
originates from the cisterna chili in the abdominal cavity at the level of the
second lumbar vertebrae. It travels on the right anterior surface of the vertebral
column in the cephalad direction to enter the posterior mediastinum through the
aortic hiatus of the diaphragm. The duct then crosses to the left side of the
vertebral column between the fourth and sixth thoracic vertebrae. The duct then
terminates at the junction of the left subclavian and internal jugular vein. Due to
its proximity to the vertebral column, it is susceptible to traumatic disruption