A patient with traumatic chylothorax

Abstract

Chylothorax refers to the accumulation of chyle in the pleural cavity. Although rare, it is the most frequent cause of pleural effusion in the neonatal period. Its incidence is estimated at one in 15,000 neonates. The causes of chylothorax are multiple, and there are several major types of chylothorax defined by origin, ie, traumatic (and iatrogenic) chylothorax, medical (spontaneous) chylothorax, and congenital chylothorax. A case of neonatal chylothorax following surgery for esophageal atresia and our therapeutic approach to this entity are presented. Conservative therapy with total enteral nutrition and drainage were sufficient. Treatment for chylothorax is essentially medical, ie, pleural drainage, removal of dietary fats, treatment of any medical cause, and use of drugs to reduce production of chyle. In the event of failure or reappearance of a large effusion, surgical treatment is needed.

Low Dose of Octreotide Can be Helpful in the Management of Congenital Chylothorax

“…As mentioned above chylothorax means accumulation of chyle within the pleural cavity, and it is based on the etiology. It is usually categorized in several forms like traumatic, spontaneous, and congenital ( 1 ). Here we presented a case of CC in a newborn male with trauma birth that was successfully treated by continuous administration of low dose of octreotide.…”

“…(Triglyceride content ≥ 1.13 mmol/l with a cell count ≥ 1000 cells/µL (80% or more lymphocytes)) ( 2 ) All options of therapeutic approaches for management of CC usually begin with supportive and conservative methods. Ligation of thoracic duct, pleural absorption, and pleurodesis as the surgery methods can be useful when all medical and conservative methods fail to reduce the pleural effusion and treatment of CC ( 4 ), conservative methods include long hospitalization, thoracentesis and insertion of chest tube, total parenteral nutrition, and introduction of a MCT diet ( 1 , 4 ).…”

“…Also, octreotide is another option of conservative management that has been used in some cases for treatment of chylothorax. It is a peptide that mimics the effect of somatostatin pharmacological and results in the reduction of gastrointestinal secretions, intrahepatic venous flow, amount of triglyceride, and chyle output of pleural effusion ( 1 , 5 , 6 ). Intravenous infusion is necessary for somatostatin while octreotide can be used subcutaneously or intravenously ( 1 ).…”

“…It is a peptide that mimics the effect of somatostatin pharmacological and results in the reduction of gastrointestinal secretions, intrahepatic venous flow, amount of triglyceride, and chyle output of pleural effusion ( 1 , 5 , 6 ). Intravenous infusion is necessary for somatostatin while octreotide can be used subcutaneously or intravenously ( 1 ). Table 1 shows the studies that have previously used octreotide for the treatment of CC ( 2 - 4 , 7 - 16 ).…”

“…A rare condition in newborns called congenital chylothorax (CC) occurs when lymphatic fluid accumulates within the pleural cavity ( 1 ). Diagnosis of CC is confirmed when analysis of pleural fluid shows a triglyceride content equal to or more than 1.13 mmol/l with a cell count equal to or more than 1000 cells/µL (80% or more lymphocytes) ( 2 ).…”