Chylothorax: a review of 18 cases.

Abstract

Eighteen patients who had developed a chylothorax during a 25 year period, 1955-80, were reviewed. The chylothoraces occurred as a complication of cardiothoracic surgery in 11 patients, of whom eight were children in the first decade of life. Five cases followed operations for coarctation of the aorta and two occurred as a complication of a Blalock shunt for Fallot's tetralogy. The chylothorax was evident within 48 hours of the operation in all but two patients. In seven cases a second operation was performed to prevent further chylous leakage and in two infants the thoracic duct was ligated. The remainder of the postsurgical chylothoraces responded to either continuous drainage or repeated aspiration and a low fat diet. There were no late sequelae of chylothorax following surgery. Spontaneous chylothorax was identified in seven patients and in five of these it was bilateral. Patients with spontaneous chylothorax were all adults and, despite treatment, had a poor prognosis. Three with malignant disease and two with pulmonary lymphangioleiomyomatosis had died within two years of the appearance of the chylothorax. Two patients with chronic idiopathic chylothoraces survived for more than two years and one of these developed a secondary fibrothorax.Chylothorax, the accumulation of thoracic duct lymph or "chyle" in the pleural space,' is a relatively uncommon condition and consequently few clinicians will have experience of more

Chylothorax in Gorham's Disease

“…Chylothorax results from leakage of chyle from penetration of the lymphatic dysplasia (4), or leakage of chyle from thoracic duct due to its invasion or blockage (3,5,6). Of the non-traumatic causes of chylothorax, the most common cause is the malignant lymphoma.…”

Pleurodesis for Nonmalignant Pleural Effusions

“…111 If untreated, chylothorax may result in fibrothorax. 19 Although some authors 1 " advocate thoracotomy with ductal ligation as the preferred therapy for nontnmmatic chylothorax when conservative measures fail, pleurodesis has been used successfully in chylothorax of various causesoo. 22 (Table 1).…”

Quilotórax

“…Foi demonstrado que a drenagem pleural tem um melhor resultado que a toracocentese de alívio. (13) A nutrição parenteral total com jejum oral é rotineiramente utilizada, uma vez que tanto as dietas pobres em triglicérides quanto aquelas contendo triglicérides de cadeia média podem aumentar o débito do quilo. (13) Após a redução do débito da fístula, pode-se tentar a realização de pleurodese com agentes químicos como o talco, a tetraciclina ou o nitrato de prata.…”

“…(13) A nutrição parenteral total com jejum oral é rotineiramente utilizada, uma vez que tanto as dietas pobres em triglicérides quanto aquelas contendo triglicérides de cadeia média podem aumentar o débito do quilo. (13) Após a redução do débito da fístula, pode-se tentar a realização de pleurodese com agentes químicos como o talco, a tetraciclina ou o nitrato de prata. (8) Se a fístula estiver sem débito após o tratamento conservador, pode-se administrar dieta hipergordurosa antes da retirada do dreno, para se ter certeza do completo fechamento da mesma.…”