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Chylothorax

What is chylothorax?

This is also known as a chyle leak and is a type of pleural effusion. It happens when lymph (called chyle) fluid that forms in the digestive system accumulates in the pleural (lung) cavity. This can happen because of either disruption or obstruction of the thoracic duct. The lymph fluid ends up where it doesn’t belong.

What causes chylothorax?

It results from leakage of lymph fluid from the thoracic duct (or one of its tributaries) by either direct laceration, such as from surgery, or from nontraumatic causes. The most common nontraumatic cause is malignancy, especially lymphoma. Less common causes are left-heart failure, infections and developmental abnormalities such as Down syndrome and Noonan syndrome.

How is it diagnosed?

We can identify chylothorax by its thick and milky white appearance, because chyle contains high levels of triglycerides.

How we treat Chylothorax

Drainage of the fluid out of the pleural (lung) space is important, because the pressure that the chyle can cause will make breathing more difficult. We achieve this drainage either through the skin or a chest tube.

Another treatment option is surgical or chemical pleurodesis. This stops the leaking of lymphatic fluids by irritating the lungs and chest wall, resulting in a sterile inflammation. This causes the lung and chest wall to fuse together, which prevents the leaking of lymphatic fluids into the pleural space.

Another treatment option is pleuroperitoneal shunting. We open a channel between the pleural space and peritoneal (chest) cavity. Removing fat from the patient’s diet is also essential.

We may also use the medication octreotide, which has been shown to be beneficial. In some cases it will stop the chylothorax after a few weeks of use.

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