Chylothorax

Abstract

Chylothorax or chylous pleural effusion occurs when chyle accumulates in the pleural space usually secondary to disruption of thoracic lymphatics. Chyle is a milky, white, opalescent fluid that is formed when long-chain triglycerides in the diet are transformed into chylomicrons and very-low-density lipoproteins, which are then secreted into intestinal lacteals. These lymphatic channels coalesce to form the thoracic duct, which transports chyle and ultimately drains it into the left subclavian vein. Any injury to the duct (or its major tributaries) as it courses through the thoracic cavity can lead to a chylous effusion. Diagnosis depends on direct analysis of the fluid by assaying the triglyceride content and, at times, lipid electrophoretic pattern (chylomicrons). Management depends on the underlying cause and the individual clinical circumstances. Nonoperative options include observation, treatment of the underlying disease, dietary modification employing strict medium-chain triglyceride diet or total parenteral nutrition, therapeutic thoracentesis, tube thoracostomy with chemical pleurodesis, and embolization of the thoracic duct. Surgical management may include pleurectomy, talc poudrage, pleuroperitoneal shunting, and repair or ligation of the thoracic duct via thoracoscopy or thoracotomy.

Spontaneous Bacterial Peritonitis And Chylothorax Related To Brucella Infection In A Cirrhotic Patient

“…Measurement of triglycerides has become the standard, with a level above 110 mg/dl nearly diagnostic (17). A pleural fluid triglyceride level of > 110 mg/dL or the presence of chylomicrons in the pleural fluid defined the presence of chylothorax (18). In our case pleural fluid was milky, pleural fluid triglyceride concentration was higher than serum triglyceride and was 161 mg/dL.…”

A rare post-operative thoracic surgery complication: chylothorax

“…Different surgical treatments, including pleurodesis, mass ligation and pleurectomy, can be performed for treatment of chylothorax. Pleurectomy can be the preferred option, especially for pediatric patients with a disease that is difficult to treat [22][23][24]. Development of chylothorax after a treatment for chylothorax is surprising.…”

Chylothorax: A Rare Complication of Tube Thoracostomy

“…Because the thoracic duct crosses the mediastinum at the level of the fifth thoracic vertebra, lymphatic injury or obstruction below this level results in a right-sided pleural effusion. In contrast, lymphatic injury or obstruction above this level usually leads to a left-sided effusion (2).…”