Analysis of the etiology and treatment of chylothorax in 119 pediatric patients in a single clinical center

Wu, Chun; Wang, Yi; Pan, Zhengxia; Wu, Yuhao; Wang, Quan; Li, Yonggang; An, Youzhong; Li, Hongbo; Wang, Gang; Dai, Jiangtao

doi:10.1016/j.jpedsurg.2018.05.008

Cited by 15 publications

(13 citation statements)

References 31 publications

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“…After surgery, this can cause chylous ascites, the leakage of lymph/chyle (fat metabolite‐rich lymph collected from the small intestine (Akcali et al )), in these cavities. Chylous ascites can cause severe complications like a disruption of immunologic function, malnutrition, septic complications, neurasthenia, dehydration and metabolic acidosis, leading to prolonged hospital stays after surgery (Weniger et al ; Wu et al ; Renard et al ).…”

Section: Introductionmentioning

confidence: 99%

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Stouthandel

Veldeman

Hoof

2019

The Anatomical Record

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This review intends to rekindle efforts to map the lymphatic system by using a more modern approach, based on medical imaging. The structure, function, and pathologies associated with the lymphatic system are first discussed to highlight the need for more accurately mapping the lymphatic system. Next, the need for an interdisciplinary approach, with a central role for the anatomist, to come up with better maps of the lymphatic system is emphasized. The current approaches on lymphatic system research involving medical imaging will be discussed and suggestions will be made for an all‐encompassing effort to thoroughly map the entire lymphatic system. A first‐hand account of our integration as anatomists in the radiotherapy department is given as an example of interdisciplinary collaboration. From this account, it will become clear that the interdisciplinary collaboration of anatomists in the clinical disciplines involved in lymphatic system research/treatment still holds great promise in terms of improving clinical regimens that are currently being employed. As such, we hope that our fellow anatomists will join us in an interdisciplinary effort to map the lymphatic system, because this could, in a relatively short timeframe, provide improved treatment options for patients with cancer or lymphatic pathologies all over the world. Anat Rec, 302:1681–1695, 2019. © 2019 American Association for Anatomy

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Section: Introductionmentioning

confidence: 99%

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Stouthandel

Veldeman

Hoof

2019

The Anatomical Record

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“…However, the analysis of the available literature shows that iatrogenic factors are the most common cause (70.8%). Among surgical procedures contributing to the development of chylothorax, cardiothoracic surgeries are most prevalent, with predominance of Fontan procedures and congenital heart defect corrective surgeries (61.2%) [2], [3], [6]- [30]. A significant group undergoing these procedures were infants with genetic conditions, such as Noonan syndrome, Down syndrome or Gorham disease.…”

Section: Resultsmentioning

confidence: 99%

“…Rare, but important reasons for the development of the previously discussed effusion are: thrombosis (including thrombosis in the course of the nephritic syndrome), cancer (mainly cancers of the lymphatic system, such as: cystic hygroma, Hodgkin lymphoma, and non-Hodgkin lymphoma), intense vomiting and thoracic trauma (in 2,7% of the analyzed cases) [2], [27], [30], [37], [40], [68], [71]- [76]. In 12% of chylothorax cases, the cause could not be determined [3], [30], [34], [39], [77]- [81]. 5.…”

Section: Resultsmentioning

confidence: 99%

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Knop

Kochanowska

Piasecka

et al. 2022

J Educ Health Sport

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Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe. The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient.

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“…Those patients usually had already chest tubes, which suddenly start to present chylous fluid with oyster white color. Non-traumatic chylothorax and chylous-like disease are usually diagnosed by chest x-ray, CT-scan or sonography of the lungs because other diseases are concomitantly present (18). Bilateral effusions were most frequently observed and diagnosed.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax and Chylous-Like Diseases in Children: Clinical Management

et al. 2019

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Background: Chylothorax and chylous-like diseases are rare conditions and difficult to treat. But they may represent potentially life-threatening disorders and important causes of morbidity and prolonged hospitalization, especially in critically ill children. Conservative as well as surgical therapeutic management strategies are continuously performed at our institution, however the results have never been evaluated and no guidelines for treatment recommendations have been put into practice so far. The objective of this retrospective study was to present a comprehensive and substantial evaluation of all relevant demographic data from children with the chylothorax and chylous-like diseases and their clinical management. Methods: We retrospectively analyzed data from all children with diagnoses of chylothorax and chylous-like diseases admitted to our pediatric intensive care unit between the years 1999 and 2012. Results: Data of 34 patients were analyzed for this study. Gender distribution (M/F) was almost equal (19/15; 56%/44%). Thirty-one children (91%) developed chylothorax after surgery. Two children (6%) had idiopathic chylothorax and in one child (3%) congenital chylothorax was diagnosed. All study patients ( n = 34; 100%) received MBF/MCT therapy. We were quite successful in treating 14 children who received only this therapy, with chest tube output dropping from 100 to 4.7%. But only 11 (32%) children received somatostatin and 7 (20%) children received beta-isodona. Different surgical interventions were performed in 6 patients (17%). All study patients received chest tubes to drain the pleural fluid and hence to relieve the chyle related symptoms. Conclusion: A combination of different conservative therapies was successful in most of our patients. Prevention, early diagnosis and treatment of potential complications may further improve the success rate of conservative therapy especially in patients with postoperative chylothorax. In summary, appropriate therapy of this condition may be lengthy but can prevent significant morbidity and mortality.

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Analysis of the etiology and treatment of chylothorax in 119 pediatric patients in a single clinical center

Cited by 15 publications

References 31 publications

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Chylothorax and Chylous-Like Diseases in Children: Clinical Management

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