Chylothorax and chylous ascites: Overview, management, and nutrition

Duletzke, Nicholas T.; Király, László; Martindale, Robert G.

doi:10.1002/ncp.10973

Cited by 12 publications

(12 citation statements)

References 39 publications

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“…However, increased ascites and marked subcutaneous edema were observed ( Figure 1 c) (tumor markers at this point were CEA 3.6, CA19-9 118.0). As a low-fat, high-protein diet and intravenous nutrition have been reported to be effective in the treatment of chylous ascites [ 5 ], a subcutaneous port was inserted and the patient was started on the intravenous high-calorie nutrition. The patient had severe anorexia and was unable to take food orally; therefore, only high-calorie nutrition was administered.…”

Section: Case Presentationmentioning

confidence: 99%

Chylous Ascites Associated with Advanced Pancreatic Cancer That Improved with Appropriate Treatment: A Case Report

Imai,

Saijo,

Takenaga

et al. 2024

Current Oncology

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Chylous ascites is a rare form of ascites with high triglyceride content arising from the thoracoabdominal lymph nodes in the peritoneal cavity due to various benign or malignant etiologies, including pancreatic cancer. During cancer chemotherapy, the accumulation of ascites can lead to the deterioration of the patient’s general condition, making chemotherapy administration difficult, and resulting in a poor prognosis. We encountered a rare case of chylous ascites complicated by advanced pancreatic cancer. The patient presented with a discrepancy between the shrinkage of the pancreatic cancer and the accumulation of ascites. Therefore, we were able to promptly diagnose chylous ascites by performing biochemical tests. The patient was treated with octreotide, reportedly effective in treating chylous ascites, which rapidly improved the chylous ascites and general condition of the patient, allowing the patient to continue chemotherapy for pancreatic cancer. Therefore, physicians should consider the possibility of chylous ascites when clinically unexplained ascites are observed in patients with advanced cancer. The investigation and treatment of chylous ascites should be initiated as soon as possible.

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Section: Case Presentationmentioning

confidence: 99%

Chylous Ascites Associated with Advanced Pancreatic Cancer That Improved with Appropriate Treatment: A Case Report

Imai,

Saijo,

Takenaga

et al. 2024

Current Oncology

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“…Occasionally, a chylothorax can occur in the context of liver cirrhosis ( 31 ), and is an important differential to consider; nevertheless, this is usually easy to distinguish from uncomplicated HH, based on its high triglyceride composition and milky appearance, often with co-existent chylous ascites ( 32 ). A more concerning differential and potential complication of HH is spontaneous bacterial empyema (SBEM).…”

Section: Diagnosismentioning

confidence: 99%

Hepatic hydrothorax

Wilkins,

Britt,

Bhatnagar

et al. 2024

J Thorac Dis

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Hepatic hydrothorax (HH) refers to the presence of a pleural effusion that develops in the context of underlying liver cirrhosis and portal hypertension. It carries a high risk of morbidity and mortality, with a median survival of 8–12 months. Diagnosis is usually confirmed by pleural aspiration, demonstrating typical features of a transudative effusion in the absence of co-existent cardio-pulmonary or renal pathology. The clinical presentation is quite variable, with some patients remaining relatively asymptomatic in the presence of small or incidental effusions, while others present with frank respiratory failure requiring pleural intervention. The development of spontaneous bacterial empyema (SBEM) is a significant and not infrequent complication, requiring prompt recognition and treatment. While the mainstay of management is focused on optimising fluid balance through dietary salt restriction and diuretic therapy, liver transplantation remains the definitive treatment option. As such, it is crucial to adopt a multi-disciplinary approach—involving pulmonologists, hepatologists, dieticians, and palliative care physicians—in order to optimise care for this often complex group of patients. This review will discuss the basic pathophysiology of HH, its clinical presentation and diagnosis, as well as the approach to management of HH in clinical practice, focussing on both interventional and non-interventional treatment modalities.

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“…In general, a conservative approach, including drainage of the effusion, nutritional modifications, and pharmacological adjuncts, is adopted first line for a limited period of time, before more invasive interventional measures are considered ( 15 ). The primary aim of these conservative measures is to reduce the flow of chyle through the thoracic duct to allow the leak to heal itself ( 86 , 87 ).…”

Section: Managementmentioning

confidence: 99%

“…For instance, corticosteroids may be utilised in sarcoidosis; guideline-directed medical therapy (in particular, diuretic medication) can be used in both chylous ascites and chylothorax secondary to heart failure; and mTOR inhibitors (such as sirolimus) can be used in chylothorax associated with LAM ( 2 , 11 , 48 , 91 ). In malignant chylothorax, treatments targeted at the underlying malignancy, such as radiotherapy or chemotherapy, can be effective in managing the chylothorax ( 12 , 14 , 87 , 92 ).…”

Section: Managementmentioning

confidence: 99%

“…Oral or enteral dietary modifications are often adopted first line in low output chylothorax ( 11 , 15 , 93 ). Patients should be assessed by dieticians and instructed to stay on a low or no-fat, high protein diet, ensuring that any fats ingested are MCTs ( 12 , 87 , 94 ). This serves to decrease fat absorption from the gut, thereby reducing the volume of chyle flow through the thoracic duct.…”

Section: Managementmentioning

confidence: 99%

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Chylothorax: pathophysiology, diagnosis, and management—a comprehensive review

Bhatnagar,

Fisher,

Ramsaroop

et al. 2024

J Thorac Dis

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Chylothorax is a rare condition characterized by the accumulation of chyle in the pleural space. While it accounts for a small percentage of pleural effusions, chylothorax can lead to significant morbidity and mortality. This article provides a comprehensive overview of chylothorax, covering its relevant anatomy, aetiology, pathophysiology, clinical features, diagnosis, and management. Injury or disruption to the thoracic duct (which is responsible for chyle transport) leads to the development of chylothorax. This may result from trauma, such as iatrogenic injury during surgery, or non-traumatic causes, including malignancy, lymphatic disorders, and heart failure. Recognition of the underlying cause is essential to tailor management. Clinical presentation varies, with symptoms linked to rate of chyle accumulation and the causative condition. Diagnosis relies on pleural fluid analysis, with demonstration of elevated triglyceride levels (>110 mg/dL) and reduced cholesterol levels (<200 mg/dL) being the key diagnostic criteria employed in clinical practice. Various imaging modalities, including computed tomography (CT) scans and lymphatic-specific investigations, may be utilised to aid identification of the site of chyle leak, as well as determine the likely underlying cause. Chylothorax management is multifaceted, with conservative approaches such as dietary modification and pharmacological interventions often initiated as first-line treatment. Drainage of chylous effusion may be necessary for symptom relief. When conservative methods fail, interventional procedures like thoracic duct ligation or embolization can be considered. Due to the diverse aetiological factors and patient characteristics associated with chylothorax, individualized management strategies are recommended. Nonetheless, management of chylothorax is an evolving field with a paucity of high-quality evidence or standardized guidelines, highlighting the importance of ongoing research and a multidisciplinary approach to optimize individual patient care.

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Chylothorax and chylous ascites: Overview, management, and nutrition

Cited by 12 publications

References 39 publications

Chylous Ascites Associated with Advanced Pancreatic Cancer That Improved with Appropriate Treatment: A Case Report

Chylous Ascites Associated with Advanced Pancreatic Cancer That Improved with Appropriate Treatment: A Case Report

Hepatic hydrothorax

Chylothorax: pathophysiology, diagnosis, and management—a comprehensive review

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