The changing management of chylothorax in the modern era

Abstract

Initial conservative therapy is applied to all cases of chylothorax (CTx) with expected excellent outcomes. The indication for aggressive surgical treatment of early CTx remains uncertain and requires rigorous scientific scrutiny. Lymphangiography and lymphoscintigraphy are useful to localize the leak and assess thoracic duct patency as well as to differentiate partial from complete thoracic duct transection. The aetiology of the CTx, flow rate and patient condition dictate the preferred management. Octreotide/somatostatin and etilefrine therapy is highly efficacious in the conservative management of CTx. For patients in whom conservative management fails, those who are good surgical candidates, and those in whom the site of the leak is well identified, surgical repair and/or ligation using minimally invasive techniques is highly successful with limited adverse outcomes. Similarly, if the site of the chylous effusion cannot be well visualized, a thoracic duct ligation via video-assisted thoracic surgery is the gold standard approach. A pleuroperitoneal or less often a pleurovenous shunt is a final option and may be curative in some patients.

Bilateral Chylothorax: Which is to Blame?

“…Octreotide is a synthetic analogue of somatostatin that inhibits the secretion of growth hormone, glucagon, insulin and reduce the lymph fluid excretion. Octreotide also reduces splanchnic blood flow and secretion of water and electrolytes and it is highly efficacious in the conservative management of chylothorax (10). A fat restricted diet and octreotide were given and aspergillus infection was treated by antifungal agents in this patient.…”

Editorial: postoperative chylothorax—a cause for concern

“…This complication has not been reported previously in conjunction with a right-sided surgical approach in the neck, but there are several case reports of chylothorax after left-sided neck incisions in association with thyroid surgery or radical neck dissection for cancer [4]. It is also a rare but well-known complication after thoracic surgery such as pneumonectomy, lobectomy, esophageal surgery and even after heart surgery [1,3]. Chylous leakage after surgical trauma may accumulate in the pleural space (chylothorax) or around the heart (chylopericardium).…”

Recurrent Chylothorax Caused by a Retained Guidewire in a Central Vein: A Case Report

“…Nontraumatic chylothorax results from increased superior vena cava pressure due to malignancy, lymphangioleiomyomatosis, sarcoidosis, cirrhosis, tuberculosis, or thrombosis causing venous obstruction 2,3) . As the correction of underlying causes is the first and best treatment option for nontraumatic chylothorax, the causative factors should be evaluated.…”