Nontraumatic Chylothorax and Chylopericardium: Diagnosis and Treatment Using an Algorithmic Approach Based on Novel Lymphatic Imaging

Gurevich, Alexey; Hur, Saebeom; Singhal, Sunil; DiBardino, David M.; Haas, Andrew R.; Hansen-Flaschen, J.H.; Nadolski, Gregory J.; Itkin, Maxim

doi:10.1513/annalsats.202103-262oc

Cited by 18 publications

(16 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is quite a liberal manner to step “back and forth” on the intensity of fat restriction without using a standard fixed protocol. Strategies that have been successful in shortening time to resolution of chylothorax and chest tube utilization in the pediatric population are specific steroids (hydrocortisone, dexamethasone, and methylprednisolone) and furosemide ( 14 ), thoracic duct embolization ( 9 , 15 , 16 ) and protocolized management ( 9 , 17 ). Most protocols categorized the severity of chylothorax by the volume of chyle output, using a cut-off of 20 mL/kg/day.…”

Section: Discussionmentioning

confidence: 99%

“…The use of many non-surgical interventions reported in postoperative chylothorax, were hardly observed in our study including steroids, propranolol, chemical pleurodesis, and intravenous immunoglobulin ( 4 , 6 , 8 , 9 , 14 , 23 ). Further, the thoracic duct embolization, which was identified as another effective, less-invasive option for chylothorax in recent years ( 9 , 15 , 16 ), is not available at our institute. Therefore, at our institution, thoracic duct ligation was a safe option when available less-invasive treatment options failed.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute

Ruangnapa¹,

Anuntaseree²,

Saelim³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

Background: Chylothorax is an uncommon cause of pleural effusion in children. This study aimed to determine the characteristics, treatment strategies, and outcomes of chylothorax in children from a single institute. Methods:The 65 episodes of chylothorax in patients aged 0-15 years who were diagnosed and received treatment in Songklanagarind Hospital between January 2001 and December 2020 were retrospectively review and analyzed.Results: Of the 65 episodes, 80% were postoperative chylothorax, and were mostly related to cardiac surgery. The most common treatment strategy employed was dietary modification (64.6%). Octreotide was used as adjunctive therapy in 33.8%. Most cases of chylothorax were successfully treated by conservative treatment, while 10.7% required surgical therapy. The median time to resolution of chylothorax was 21 days [interquartile range (IQR): 8-33 days]. Young children aged <1 year were more likely to require mechanical ventilation and develop ventilator-associated pneumonia and catheter-related complications. The factors associated with death or prolonged hospitalization (>28 days) were non-postoperative chylothorax, use of total parental nutrition (TPN) >14 days, hypoalbuminemia, and ventilator-associated pneumonia.Conclusions: Most (89.2%) cases of chylothorax were successfully treated conservatively using dietary modification and octreotide therapy. The modifiable risk factors for death or prolonged hospitalization were use of TPN >14 days and hypoalbuminemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute

Ruangnapa¹,

Anuntaseree²,

Saelim³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…PLPS may manifest as idiopathic chylothorax or chylopericardium, neonatal chylothorax, or plastic bronchitis following cardiothoracic surgery or secondary to inflammatory conditions ( Fig. 8 ) [ 4 5 40 41 ]. PLPS may go undetected until later in life, when the patient develops symptoms secondary to elevated central venous pressure, trauma, or infection.…”

Section: Classification Of Lymphatic Disorders From the Perspective O...mentioning

confidence: 99%

“…It should be noted that idiopathic chylothorax should be differentiated from the secondary accumulation of chyle in the pleural space in chylous ascites. The chyle from the peritoneum can pass freely from the peritoneal cavity into the pleural space through diaphragmatic fenestrations [ 40 ]. Negative pressure in the thoracic cage causes a pressure gradient between the two spaces, which drives the lymph across the diaphragm.…”

Section: Classification Of Lymphatic Disorders From the Perspective O...mentioning

confidence: 99%

Lymphatic Intervention, the Frontline of Modern Lymphatic Medicine: Part II. Classification and Treatment of the Lymphatic Disorders

et al. 2023

Self Cite

View full text Add to dashboard Cite

Lymphatic disorders encompass a broad spectrum of diseases involving the lymphatic system, ranging from traumatic lymphatic leaks to lymphatic malformations. Lymphatic disorders can be categorized into traumatic and non-traumatic disorders according to their etiology. These two categories may be further divided into subgroups depending on the anatomical location of the lymphatic pathology and their association with clinical syndromes. Thoracic duct embolization was a milestone in the field of lymphatic intervention that encouraged the application of percutaneous embolization techniques to treat leaks and reflux disorders in the lymphatic system. Additional access routes for embolization, including retrograde thoracic duct and transhepatic lymphatic access, have also been developed. This article comprehensively reviews a variety of options for the treatment of lymphatic disorders, from conservative management to the most recent embolization techniques.

show abstract

“…In this issue of AnnalsATS , Gurevich and colleagues (pp. 756–762 ) present their experience using an algorithm-based approach to map out management plans for nontraumatic chylous effusions ( 8 ). The authors used novel dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) to delineate primary site(s) of the lymphatic defect resulting in the clinical syndrome of chylous effusion and/or ascites (i.e., thoracic, retroperitoneal, or transdiaphragmatic), and this information subsequently guided a lymphatic intervention.…”

mentioning

confidence: 99%

Chyle in the Wrong Place: Why Knowing the Target Matters

Iqbal

Rahman

2022

Annals ATS

View full text Add to dashboard Cite

Nontraumatic Chylothorax and Chylopericardium: Diagnosis and Treatment Using an Algorithmic Approach Based on Novel Lymphatic Imaging

Cited by 18 publications

References 24 publications

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute

Lymphatic Intervention, the Frontline of Modern Lymphatic Medicine: Part II. Classification and Treatment of the Lymphatic Disorders

Chyle in the Wrong Place: Why Knowing the Target Matters

Contact Info

Product

Resources

About