13.

CHYLOTHORAX

PLEURAL DISEASES SERIES 08

BY WIDIRAHARDJO

13. CHYLOTHORAX

When pleural fluid is milky or at

least turbid that persists after
centrifugation, it is almost
always due to a high lipid
content of the pleural fluid is
said a chylothorax.
A chylothorax is formed when
the thoracic duct is disrupted and
chyle enters the pleural space.

13. CHYLOTHORAX

Chyle is bacteriostatic and does

not become infected even when
it stands at room temperature for
several weeks.
Ligation of the thoracic duct at
any point in its course does not
produce a chylothorax
presumably as a result of the
many collateral vessels and
lymphaticovenous anastomoses.

13. CHYLOTHORAX

The causes of chylothoraces was: surgery

or trauma, malignancy (lymphoma),
congenital or acquired lymphatic
disorders, chylous ascites, miscellaneous
medical causes and no identifiable cause.
CT studies of the mediastinum should be
performed in all patients with
nontraumatic chylothorax to ascertain
whether mediastinal lymphadenopathy is
present.
The diagnosis of chylothorax is usually not
difficult because chyle usually has a
distinctive white, odorless, milky
appearance.

13. CHYLOTHORAX

If the pleural fluid triglyceride level is

above 110 mg/dL the diagnosis of
chylothorax is established.
The imaging of the thoracic duct can be
performed by lymphoscintigraphy.
The main danger to patients with
chylothorax is that they become
malnourished and immunocompromised
because of the removal of large amounts
of protein, fat, electrolytes, and
lymphocytes from the body with repeated
thoracentesis or chest tube drainage.

13. CHYLOTHORAX

Mortality rate from chylothorax

approached 50%.
So we must treat the chylothorax
definitively, such as with thoracic
duct ligation or pleuroperitoneal
shunt implantation.
The general aims the treatment are
relief of dyspnea by removal of the
chyle, prevention of dehydration,
maintenance of nutrition, and a
reduction in the rate of chyle
formation:

13. CHYLOTHORAX

Tube thoracostomy
Intravenous hyperalimentation
Reinfused directly from the chest
tube into the subclavian vein
Diet with mediumchain triglycerides
Pleuroperitoneal shunt
percutaneously embolize the
thoracic duct using a transabdominal
approach
Pleurodesis through tube
thoracostomy

13. CHYLOTHORAX

- Thoracoscopy with pleural

abrasion or partial pleurectomy
to create a pleurodesis
- Thoracoscopy with attempted
ligation of the thoracic duct
- Thoracotomy with ligation of the
thoracic duct