Nontraumatic chylothorax

Nontraumatic chylothorax is an uncommon condition of thoracic or abdominal origin caused by multiple disorders, of which malignancy is by far the most frequent one. Because gross appearance of pleural fluid is frequently misleading, pleural fluid and serum lipid analysis is required for its diagnosis. In addition to the presence of chylomicrons, chylothoraces are usually characterized by all three of the following: (1) a triglyceride level of more than 110 mg/dL; (2) a ratio of pleural fluid to the serum triglyceride level of more than 1.0; and (3) a ratio of the pleural fluid to serum cholesterol level of less than 1.0. In patients with lymphoma-related chylothorax refractory to chemotherapy and radiation therapy, medical thoracoscopic talc pleurodesis has an acceptable complication rate and a 100% success rate in the prevention of recurrences. Pleuroperitoneal shunting is considered a safe and effective treatment in the management of persistent chylothorax in children in the absence of chylous ascites.     

Octreotide for treating chylothorax after cardiac surgery

Chylothorax is a rare but serious complication of cardiac surgery, with a poor prognosis unless treated properly. We report the case of 66-year-old woman who developed chylothorax after coronary artery bypass grafting. The chylothorax was successfully treated in 8 days by means of subcutaneous octreotide administration and a diet that contained medium-chain triglycerides. Octreotide, a long-acting somatostatin analog, is an effective and safe agent for the treatment of postoperative chylothorax and may reduce the need for reoperation.     

Octreotide for conservative management of postoperative chylothorax

Postoperative chylothorax after lung resection is a major problem leading to morbidity and mortality and requiring reoperation in a large number of cases. The most advisable and least aggressive option is conservative management in progressive stages: a diet rich in medium-chain fatty acids and/or total parenteral nutrition, in addition to chest tube drainage. Including octreotide in this regimen seems to be related to a higher success rate without the need for surgery. We report a case in which the effectiveness and safety of octreotide in the resolution of postoperative chylothorax was excellent.     

Octreotide and chylothorax

PURPOSE OF REVIEW: This article reviews the current literature concerning the role of somatostatin and its synthetic analogue, octreotide, in the treatment of chylothorax. RECENT FINDINGS: Management of chylothorax includes evacuation of the pleural cavity through a chest tube to alleviate dyspnoea, and dietary fat restriction aimed at reducing lymph flow. When these measures fail to control lymph flow, surgical interventions are employed to achieve definite closure of the thoracic duct leak. Several case reports and series have shown that octreotide is safe and probably effective in both children and adults with chylothorax of different origins. The property of somatostatin and octreotide to induce leak closure is attributed to a decelerating effect on lymph flow, although their exact mechanism of action is not well defined. In successful cases, a substantial reduction of lymph drainage through the chest tube is evident within the first few days of commencing the drug, and treatment lasts for 1-2 weeks. Treatment failure has been also reported, however. SUMMARY: Accumulating evidence suggests that octreotide is a putative novel therapeutic intervention for chylothorax. It is imperative that randomized controlled studies are conducted in order to fully elucidate the efficacy and safety of this treatment.     

Simvastatin indused chylothorax

Chylothorax is a rare disorder occurring most often in aftermath of a thoracic surgery or during cancer of mediastinum. We report the clinical history of the world's second case of chylothorax which appeared during treatment with simvastatin.     

Bilateral traumatic chylothorax

We report the case of a 27-year-old man with bilateral chylothorax. The patient presented with shortness of breath and bilateral pleural effusions three days after a motor vehicle accident. The diagnosis was established when tube thoracostomy revealed chylous drainage. During hospitalization approximately 8 L of chyle were removed. Bilateral chylothorax secondary to blunt trauma has rarely been reported. The etiology, pathogenesis, clinical presentation, and recommended therapy are reviewed.     

Relapse of idiopathic chylothorax 17 years after remission of congenital chylothorax]

We report a case of chylothorax in a 17-year-old male. As a neonate, had had congenital chylothorax, and was successfully treated with medium-chain triglycerides; but recently presented with dyspnea after an episode of severe coughing. Radiographic examination disclosed abundant effusion in the right chest. The effusion was milky brown, had a creamy supernatant and a high triglyceride level (3085 mg/dl). This condition was diagnosed as idiopathic chylothorax. Lymphangiography showed a rupture of the right thoracic duct. Since the effusion was resistant to conservative therapy, we performed thoracoscopic clipping of the thoracic duct, which reduced the amount of pleural effusion. We speculated that coughing may have caused the rupture of a congenitally weakened thoracic duct.     

Giant substernal goiter with chylothorax

A 60-year-old woman presented with a huge goiter extending from the lower jaw to the diaphragm. Right pleurocentesis produced chylous fluid. A cervicothoracic incision was used to totally excise the substernal goiter, with near-total excision of the cervical goiter, and repair of the lymphatic leakage.     

Congenital pulmonary lymphangiectasia with chylothorax

A 5-year-old boy with dyspnea was diagnosed through thoracentesis as having chylothorax. After conservative management failed, open thoracotomy was performed. Lung biopsy confirmed the diagnosis of congenital pulmonary lymphangiectasia. Chylothorax was successfully controlled by fibrin glue pleurodesis in this patient.     

Treatment of chylothorax with elemene

BACKGROUND: Chylothorax is a disorder with a variety of causes and is often difficult and complex to manage. There are two treatment options for chylothorax: conservative management or surgical intervention. Conservative management of chylothorax consists of pleural fluid drainage, supportive ventilation, supplementation of fluid loss, and elemental diet or total parenteral nutrition. Surgical repair often results in significant morbidity and mortality. Pleurodesis is also an appropriate method of treatment. Elemene, an extract of the ginger plant, is also a sclerosing agent and can be used for pleurodesis. METHODS: In this study, 23 consecutive patients were treated for high-output chylothorax. 0.5 % elemene emulsion injection (40 ml) was injected into the pleural cavity. The injection can be repeated if necessary. RESULTS: All patients experienced resolution of symptoms. 7 patients received sclerotherapy with elemene once, 11 patients received it twice and 4 patients received it three times. 1 patient required five applications of elemene. The side effects included chest pain and fever but were considered sustainable. CONCLUSION: Elemene is an effective and safe treatment for patients with chylothorax.     

Management of chylothorax via percutaneous embolization

PURPOSE OF REVIEW: The purpose of this review is to present a novel radiologic percutaneous transabdominal technique for treating high-output chylothorax by thoracic duct embolization, and to demonstrate that it can be potentially safer than the traditional treatment by surgical open-chest thoracic duct ligation. RECENT FINDINGS: Pedal lymphography is initially performed to opacify large retroperitoneal lymph channels; a suitable duct more than 2 mm in diameter is then punctured transabdominally to allow catheterization and embolization of the thoracic duct under fluoroscopic guidance. If feeding lymphatic channels are too small for catheterization, they can often be occluded by needle disruption. This percutaneous interventional technique, which has been used in 60 patients with mostly high-output chylothorax caused by thoracic surgery, resulted in a 65% cure rate with no morbidity. Back-up surgical thoracic duct ligation was performed promptly on suitable lower risk patients when the percutaneous procedure failed. SUMMARY: We have found that two thirds of patients presenting with life-threatening chylothorax can be safely treated by percutaneous transabdominal thoracic duct blockage. When successful, this novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays.     

Somatostatin in the treatment of chylothorax

A case report is presented of spontaneous chylothorax successfully treated by conservative means. The helpful role of the inhibitory peptide, octreotide, is discussed.