Chylothorax and pseudochylothorax

Abstract

Chylothorax is the occurrence of chylus (lymph) in the pleura due to damage to the thoracic duct. There is a high content of triglycerides, and chylomicrons can be seen. It is usually right-sided, since most of the duct is within the right hemithorax. With damage at the level of the aorta, the chyle will appear on the left.Traumatic rupture occurs after accidents or surgery. Of nontraumatic causes, the most common is a malignant lymphoma. Computed tomography (CT) scan of the thorax and upper abdomen should be performed. Lymphography can show where the leakage or blockage is situated. With repeated drains, large amounts of fat, proteins, and lymphocytes are lost. Treatment is with low-fat diet or parenteral nutrition to decrease the amount of chyle, but chemical pleurodesis or ligation of the thoracic duct, usually via thoracoscopy, is often necessary.Pseudochylothorax (cholesterol pleurisy) occurs with long-standing fluid in a fibrotic pleura. The fluid has a high content of cholesterol but no triglycerides or chylomicrons. In both conditions, the pleural fluid is thick, opalescent, whitish or the colour of café-au-lait.

Bilateral chylothorax complicating bibasilar pneumonia: A case report

“…Nontraumatic, nonmalignant causes of chylothorax include tuberculosis, histoplasmosis, amyloidosis, sarcoidosis, lymphangiomyomatosis, filariasis, superior vena cava obstruction, retrosternal goiter, haemangiomatosis and yellow nail syndrome [5] . Medical devices such as central venous pressure lines and pacemakers are potential iatrogenic causes of chylothorax.…”

Chylothorax in Infants and Children

“…1 Many anatomic variations can exist in all portions of the thoracic duct. 5,6 Chyle is a noninflammatory, alkaline, and bacteriostatic fluid composed mainly of fat, cholesterol, electrolytes, proteins, glucose, and abundant lymphocytes (Table 1). 2 The protein content of chyle is usually .3 g/L, and the electrolyte composition is similar to that of serum.…”

“…2 Nonoperative management of chylothorax in children is successful in .80% of reported cases, including those patients with chylothorax after cardiothoracic surgery. 5,39,[52][53][54]106,107 To reduce the flow of chyle through the thoracic duct while waiting for spontaneous healing to occur, a fat-free diet with the addition of medium-chain triglycerides is instituted. Medium-chain triglycerides with saturated fatty acids of 8 to 12 carbon chain lengths are absorbed directly into the portal venous system, bypassing lymphatic drainage.…”

Minimal Lymphatic Leakage in an Infant With Chylothorax Detected by Lymphoscintigraphy SPECT/CT

“…1 The condition should be occasionally differentiated from pseudochylothorax (cholesterol pleurisy), which represents long-standing fluid in a fibrotic pleura with a high content of cholesterol but no triglycerides or chylomicrons. 3 Chylothorax is commonly associated with significant morbidity and mortality. If the leaking vessel cannot be identified, this may limit the treatment options to such procedures as drainage of the fluid out of the pleural space and omitting fat from the diet, pneumoperitoneal shunting, or surgical or chemical pleurodesis.…”

“…The diagnosis is commonly confirmed by the presence of chylomicrons and triglycerides in the aspirated pleural fluid. [1][2][3][4] In children, pleural effusion is usually defined as chyle when it contains .1.1 mmol/L triglycerides (with oral fat intake) and has a total cell count $1000 cells/mL with a lymphocyte fraction .80%. 1 The condition should be occasionally differentiated from pseudochylothorax (cholesterol pleurisy), which represents long-standing fluid in a fibrotic pleura with a high content of cholesterol but no triglycerides or chylomicrons.…”