Chylothorax: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(58 intermediate revisions by the same user not shown)
Line 14: Line 14:
}}
}}
{{SI}}
{{SI}}
{{CMG}}''' Associate Editor:''' {{JE}}
{{SK}} Chylothorax


==Overview==
==Overview==
Chylothorax, a type of [[pleural effusion]] is the accumulation of [[chyle]] in the [[pleural cavity]] secondary to destruction or obstruction of the [[thoracic duct]] or its tributaries. It is an uncommon but established complication of [[thoracic surgery]]. Chylothorax is most commonly right-sided (50%) because of the anatomic location of the [[thoracic duct]], left-sided (33.3%), or bilateral (16.66%). [[Thoracic duct]] damage above the fifth [[Thoracic vertebrae|thoracic vertebra]] results in a left-sided chylothorax whereas damage to the [[thoracic duct]] below fifth [[Thoracic vertebrae|thoracic vertebra]] leads to a right-sided effusion. Some common symptoms of chylothorax include [[dyspnea]], [[cough]], and severe [[chest pain]]. Some physical exams finding include decreased [[breath sounds]] and dullness to [[percussion]] depending on the size and location of fluid. The definitive diagnosis of chylothorax is with [[thoracentesis]] and analysis of the [[Pleural effusion|pleural fluid]] showing a reduced concentration of [[cholesterol]] <200mg/dl, and an elevated concentration of  [[triglyceride]] >110 mg/dl.  Management of chylothorax may be conservative or surgical. Conservative management include [[total parenteral nutrition]], oral low-fat medium-chain [[triglyceride]], and [[octreotide injection]]s. Surgical management include [[Chest tube|tube thoracostomy]], [[pleurodesis]], pleurectomy, pleuroperitoneal shunt, and [[thoracic duct]] ligation.
Chylothorax, a type of [[ pleural effusion]] is the accumulation of [[chyle]] in the [[pleural cavity]] secondary to destruction or obstruction of the [[thoracic duct]] or its tributaries.  Depending on the etiology, chylothorax could be [[Pleural effusion classification|exudative]] ( [[tuberculosis]]) or [[Pleural effusion classification|transudative]] ([[Superior vena cava syndrome|svc obstruction]]). It is an uncommon but established complication of [[thoracic surgery]]. Chylothorax is most commonly right-sided (50%) because of the anatomic location of the [[thoracic duct]], left-sided (33.3%), or bilateral (16.66%). [[Thoracic duct]] damage above the fifth [[Thoracic vertebrae|thoracic vertebra]] results in a left-sided chylothorax whereas damage to the [[thoracic duct]] below fifth [[Thoracic vertebrae|thoracic vertebra]] leads to a right-sided effusion. Some common symptoms of chylothorax include [[dyspnea]], [[cough]], and severe [[chest pain]]. Some physical exams finding include decreased [[breath sounds]] and dullness to [[percussion]] depending on the size and location of fluid. The definitive diagnosis of chylothorax is with [[thoracentesis]] and analysis of the [[Pleural effusion|pleural fluid]] showing a reduced concentration of [[cholesterol]] <200mg/dl, and an elevated concentration of  [[triglyceride]] >110 mg/dl.  Management of chylothorax may be conservative or surgical. Conservative management include [[total parenteral nutrition]], oral low-fat medium-chain [[triglyceride]], and [[octreotide injection]]s. Surgical management include [[Chest tube|tube thoracostomy]], [[pleurodesis]], pleurectomy, pleuroperitoneal shunt, and [[thoracic duct]] ligation.


==Historical Perspective==
==Historical Perspective==
Line 84: Line 87:


==Pathophysiology==
==Pathophysiology==
It is thought that chylothorax is the result of leakage of [[chyle]] from the [[thoracic duct]] or its tributaries. Leakage may be sure to trauma (most common cause), disruption or obstruction.
*It is thought that chylothorax is the result of obstruction, difficulty in drainage of [[Lymphatic system|lymph]], [[Lymphatic system|lymphatic malformation]] or laceration of the [[thoracic duct]] leading to leakage of [[chyle]] into the [[pleural cavity]].<ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624  }} </ref>
*Chylothorax as a result of [[tuberculosis]] is thought to be due to enlargement of the [[Lumbar lymph nodes|lumbar]] and the [[iliac lymph node]]s producing obstruction of the [[cisterna chyli]] and [[thoracic duct]]. This leads to dilatation of the [[Lumbar lymph nodes|lumbar]] channels, followed by the opening of collateral [[anastomosis]]. With the many lymphaticovenous [[anastomosis]] existing between the [[thoracic duct]], and the [[Azygos vein|azygos]], [[Intercostal veins|intercostal]], and [[Lumbar veins]]. The increased pressure in the system results in the transudation of [[chyle]] into the [[pleural cavity]].<ref name="pmid21654988">{{cite journal| author=Kant S, Verma SK, Anand SC, Prasad R, Verma RK| title=Development of bilateral chylothorax in a younger female secondary to tuberculosis. | journal=Lung India | year= 2011 | volume= 28 | issue= 1 | pages= 56-9 | pmid=21654988 | doi=10.4103/0970-2113.76303 | pmc=3099513 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21654988  }} </ref>
*Chylothorax as a result of [[tuberculosis]] is thought to be produced by the enlargement of the [[Lumbar lymph nodes|lumbar]] and the [[iliac lymph node]]s producing obstruction of the [[cisterna chyli]] and [[thoracic duct]]. This leads to dilatation of the [[Lumbar lymph nodes|lumbar]] channels, followed by the opening of collateral [[anastomosis]]. With the many lymphaticovenous [[anastomosis]] existing between the [[thoracic duct]], and the [[Azygos vein|azygos]], [[Intercostal veins|intercostal]], and [[Lumbar veins]]. The increased pressure in the system results in the transudation of [[chyle]] into the [[pleural cavity]].<ref name="pmid21654988">{{cite journal| author=Kant S, Verma SK, Anand SC, Prasad R, Verma RK| title=Development of bilateral chylothorax in a younger female secondary to tuberculosis. | journal=Lung India | year= 2011 | volume= 28 | issue= 1 | pages= 56-9 | pmid=21654988 | doi=10.4103/0970-2113.76303 | pmc=3099513 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21654988  }} </ref>


==Causes==
==Causes==
*Common causes of chylothorax include<ref name="pmid21654988">{{cite journal| author=Kant S, Verma SK, Anand SC, Prasad R, Verma RK| title=Development of bilateral chylothorax in a younger female secondary to tuberculosis. | journal=Lung India | year= 2011 | volume= 28 | issue= 1 | pages= 56-9 | pmid=21654988 | doi=10.4103/0970-2113.76303 | pmc=3099513 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21654988  }} </ref><ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546  }} </ref>
*Common causes of chylothorax include<ref name="pmid21654988">{{cite journal| author=Kant S, Verma SK, Anand SC, Prasad R, Verma RK| title=Development of bilateral chylothorax in a younger female secondary to tuberculosis. | journal=Lung India | year= 2011 | volume= 28 | issue= 1 | pages= 56-9 | pmid=21654988 | doi=10.4103/0970-2113.76303 | pmc=3099513 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21654988  }} </ref><ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473 }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref><ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546  }} </ref><ref name="pmid19882503">{{cite journal| author=Waterfield T, Lakhoo K| title=Challenges in the management of refractory bilateral idiopathic congenital chylothoraces in a newborn. | journal=Eur J Pediatr Surg | year= 2010 | volume= 20 | issue= 3 | pages= 198-201 | pmid=19882503 | doi=10.1055/s-0029-1241874 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19882503  }} </ref><ref name="pmid31338288">{{cite journal| author=Austin A, Al-Faris F, Modi A, Chopra A| title=A transudative chylothorax associated with superior vena cava syndrome. | journal=Respir Med Case Rep | year= 2019 | volume= 28 | issue=  | pages= 100898 | pmid=31338288 | doi=10.1016/j.rmcr.2019.100898 | pmc=6626116 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31338288  }} </ref>
**[[Congenital disorder|Congenital]]
***[[Down syndrome]]
***[[Noonan syndrome]]
***[[Turner syndrome]]
**[[Cancer|Malignacy]]
**[[Cancer|Malignacy]]
**[[Sarcoidosis]]
**[[Sarcoidosis]]
**[[Tuberculosis]]
**[[Tuberculosis]]
**[[Cirrhosis]]
**[[Congestive heart failure|Heart failure]]
**[[Congestive heart failure|Heart failure]]
**[[Benign tumor]]
**[[Benign tumor]]
Line 103: Line 111:


== Differentiating chylothorax  from other Diseasess ==
== Differentiating chylothorax  from other Diseasess ==
Chylothorax must be differentiated from<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
Chylothorax must be differentiated from<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624  }} </ref>
*[[Empyema]]
*[[Empyema]]
*Pseudochylothorax  
*Pseudochylothorax  
*[[Cholesterol]] [[pleural effusion]]s
*[[Tuberculosis]]
*[[Tuberculosis]]
*Chronic [[pneumothorax]]
*Chronic [[pneumothorax]]
Line 119: Line 128:
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
*In 2011, the incidence of pediatric chylothorax was estimated to be 3.7%<ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref> <ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>  
*In 2011, the incidence of pediatric chylothorax was estimated to be 3.7%<ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref> <ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>  
**Incidence post [[Cardiac surgery|cardiothoracic surgeries]] are between 0.9% and 6.6%.  
*Incidence post [[Cardiac surgery|cardiothoracic surgeries]] are between 0.9% and 6.6%.  
***Incidence post [[Congenital heart disease|congenital cardiac anomalies]] repair is 2.8%4.
**Incidence post [[Congenital heart disease|congenital cardiac anomalies]] repair is 2.8%.
**Incidence post [[esophageal]] surgeries range from 0.2% to 10%.
*Incidence post [[esophageal]] surgeries range from 0.2% to 10%.
   
   
===Age===
===Age===
Line 127: Line 136:
   
   
===Gender===
===Gender===
*[Disease name] affects men and women equally.
*Chylothorax affects men and women equally.
 
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
===Race===
===Race===
*There is no racial predilection for [disease name].
*There is no racial predilection for chylothorax.
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].


==Risk Factors==
==Risk Factors==
Common risk factors in the development of Chylothorax] are<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid29249497">{{cite journal| author=Lo Rito M, Al-Radi OO, Saedi A, Kotani Y, Ben Sivarajan V, Russell JL | display-authors=etal| title=Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 5 | pages= 2069-2077 | pmid=29249497 | doi=10.1016/j.jtcvs.2017.11.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29249497  }} </ref><ref name="pmid31292394">{{cite journal| author=Sasaki H, Kimizuka Y, Ogata H, Okada Y, Ota S, Sano T | display-authors=etal| title=Successful Control of Dasatinib-related Chylothorax by the Japanese Herbal Medicine "Goreisan". | journal=Intern Med | year= 2019 | volume= 58 | issue= 21 | pages= 3139-3141 | pmid=31292394 | doi=10.2169/internalmedicine.3002-19 | pmc=6875454 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31292394  }} </ref><ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref><ref name="pmid29106894">{{cite journal| author=Nicastri DG, Flores RM| title=Chylothorax: Abdominal approach. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 2 | pages= 814 | pmid=29106894 | doi=10.1016/j.jtcvs.2017.09.111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29106894  }} </ref><ref name="pmid17251600">{{cite journal| author=Townshend AP, Speake W, Brooks A| title=Chylothorax. | journal=Emerg Med J | year= 2007 | volume= 24 | issue= 2 | pages= e11 | pmid=17251600 | doi=10.1136/emj.2006.042028 | pmc=2658219 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17251600  }} </ref><ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref><ref name="pmid30626415">{{cite journal| author=Pospiskova J, Smolej L, Belada D, Simkovic M, Motyckova M, Sykorova A | display-authors=etal| title=Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders. | journal=Orphanet J Rare Dis | year= 2019 | volume= 14 | issue= 1 | pages= 9 | pmid=30626415 | doi=10.1186/s13023-018-0991-3 | pmc=6327395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30626415  }} </ref><ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546  }} </ref>
Common risk factors in the development of Chylothorax] are<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid29249497">{{cite journal| author=Lo Rito M, Al-Radi OO, Saedi A, Kotani Y, Ben Sivarajan V, Russell JL | display-authors=etal| title=Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 5 | pages= 2069-2077 | pmid=29249497 | doi=10.1016/j.jtcvs.2017.11.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29249497  }} </ref><ref name="pmid31292394">{{cite journal| author=Sasaki H, Kimizuka Y, Ogata H, Okada Y, Ota S, Sano T | display-authors=etal| title=Successful Control of Dasatinib-related Chylothorax by the Japanese Herbal Medicine "Goreisan". | journal=Intern Med | year= 2019 | volume= 58 | issue= 21 | pages= 3139-3141 | pmid=31292394 | doi=10.2169/internalmedicine.3002-19 | pmc=6875454 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31292394  }} </ref><ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref><ref name="pmid29106894">{{cite journal| author=Nicastri DG, Flores RM| title=Chylothorax: Abdominal approach. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 2 | pages= 814 | pmid=29106894 | doi=10.1016/j.jtcvs.2017.09.111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29106894  }} </ref><ref name="pmid17251600">{{cite journal| author=Townshend AP, Speake W, Brooks A| title=Chylothorax. | journal=Emerg Med J | year= 2007 | volume= 24 | issue= 2 | pages= e11 | pmid=17251600 | doi=10.1136/emj.2006.042028 | pmc=2658219 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17251600  }} </ref><ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref><ref name="pmid30626415">{{cite journal| author=Pospiskova J, Smolej L, Belada D, Simkovic M, Motyckova M, Sykorova A | display-authors=etal| title=Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders. | journal=Orphanet J Rare Dis | year= 2019 | volume= 14 | issue= 1 | pages= 9 | pmid=30626415 | doi=10.1186/s13023-018-0991-3 | pmc=6327395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30626415  }} </ref><ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546 }} </ref><ref name="pmid31341753">{{cite journal| author=Jacob S, Meneses A, Landolfo K, El-Sayed Ahmed M, Makey IA, Pham SM | display-authors=etal| title=Incidence, Management, and Outcomes of Chylothorax after Lung Transplantation: A Single-center Experience. | journal=Cureus | year= 2019 | volume= 11 | issue= 7 | pages= e5190 | pmid=31341753 | doi=10.7759/cureus.5190 | pmc=6649881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31341753  }} </ref><ref name="pmid31292374">{{cite journal| author=Nagano N, Suzuki M, Tamura K, Kobayashi S, Kojima Y, Naka G | display-authors=etal| title=Refractory Chylothorax and Lymphedema Caused by Advanced Gastric Cancer. | journal=Intern Med | year= 2019 | volume= 58 | issue= 21 | pages= 3143-3148 | pmid=31292374 | doi=10.2169/internalmedicine.2351-18 | pmc=6875443 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31292374 }} </ref>
*[[Hepatectomy]]
*[[Surgery]]
*[[Esophagectomy]]
**[[Hepatectomy]]
*[[Lung]] surgery
**[[Esophagectomy]]
*[[Cardiac surgery]]
**[[Lung]] surgery
*[[Fontan procedure]]
**[[Cardiac surgery]]
*[[Retroperitoneum|Retroperitoneal]] surgery around the [[cisterna chyli]], example [[abdominal aortic aneurysm surgery|AAA repair]]
**[[Fontan procedure]]
**[[Retroperitoneum|Retroperitoneal]] surgery around the [[cisterna chyli]], example [[abdominal aortic aneurysm surgery|AAA repair]]
*[[Dasatinib]] therapy
*[[Dasatinib]] therapy
*[[Rib fracture]]
*[[Rib fracture]]
*[[Tuberculosis]]
*[[Tuberculosis]]
*[[Stomach cancer|Gastric cancer]]
*Malignant pleural [[mesothelioma]]
*Malignant pleural [[mesothelioma]]
*Malignant [[lymphoproliferative disorders]]
*Malignant [[lymphoproliferative disorders]]


==Screening==
==Screening==
*There is insufficient evidence to recommend routine screening for chylothorax.
 
== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*If left untreated, 100% of patients with chylothorax may progress to develop<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref>
*If left untreated, 100% of patients with chylothorax may progress to develop<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref>
**[[Hypovolaemia]]
**[[Hypovolaemia]]
*[[Hypoalbuminemia]]
**[[Hypoalbuminemia]]
**[[Malnutrition]]; as a result of [[protein]], [[fats]] and [[vitamin]]s loss with [[weight loss]] and [[Muscle atrophy|muscle wasting]].
**[[Malnutrition]]; as a result of [[protein]], [[fats]] and [[vitamin]]s loss with [[weight loss]] and [[Muscle atrophy|muscle wasting]].
**[[Hyponatremia]] and [[hypocalcemia]] due to [[Electrolyte disturbance|electrolyte loss]].
**[[Hyponatremia]] and [[hypocalcemia]] due to [[Electrolyte disturbance|electrolyte loss]].
**[[Opportunistic infection]]s as a result of  [[Antibody|immunoglobulins]] loss.
**[[Opportunistic infection]]s as a result of  [[Antibody|immunoglobulins]] loss.
**Subtherapeutic effects of medications like [[digoxin]] and [[amiodarone]] as they are lost through the leaking [[chyle]].
**Subtherapeutic effects of medications like [[digoxin]] and [[amiodarone]] as they are lost through the leaking [[chyle]].
*Common complications of  chylothorax include [[malnutrition]], [[immunosuppression]] and [[respiratory distress]].<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref>
*Common complications of  chylothorax include [[malnutrition]], [[immunosuppression]] and [[respiratory distress]].<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473 }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref>
*Prognosis is generally good and the [[mortality rate]] from chylothorax has considerably improved from approximately 50% as described in 1948. This is due to the more aggressive management plans implemented. Currently, the worst prognosis is seen in malignant and bilateral chylothoraces.<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid29106894">{{cite journal| author=Nicastri DG, Flores RM| title=Chylothorax: Abdominal approach. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 2 | pages= 814 | pmid=29106894 | doi=10.1016/j.jtcvs.2017.09.111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29106894  }} </ref>
*Prognosis is generally good and the [[mortality rate]] from chylothorax has considerably improved from approximately 50% as described in 1948. This is due to the more aggressive management plans implemented. Currently, the worst prognosis is seen in malignant and bilateral chylothoraces.<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473 }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref><ref name="pmid29106894">{{cite journal| author=Nicastri DG, Flores RM| title=Chylothorax: Abdominal approach. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 2 | pages= 814 | pmid=29106894 | doi=10.1016/j.jtcvs.2017.09.111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29106894  }} </ref>


== Diagnosis ==
== Diagnosis ==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
*The diagnosis of chylothorax is with [[thoracentesis]] and analysis of the [[Pleural effusion|pleural fluid]] showing a reduced concentration of [[cholesterol]] <200mg/dl, and an elevated concentration of  [[triglyceride]] >110 mg/dl. In centres with available facilities, [[lipoprotein]] analysis showing the presence of [[chylomicron]]s is the gold standard.<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref>
*The diagnosis of chylothorax is with [[thoracentesis]] and analysis of the [[Pleural effusion|pleural fluid]] showing a reduced concentration of [[cholesterol]] <200mg/dl, and an elevated concentration of  [[triglyceride]] >110 mg/dl. In centres with available facilities, [[lipoprotein]] analysis showing the presence of [[chylomicron]]s is the gold standard.<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386 }} </ref><ref name="pmid21654988">{{cite journal| author=Kant S, Verma SK, Anand SC, Prasad R, Verma RK| title=Development of bilateral chylothorax in a younger female secondary to tuberculosis. | journal=Lung India | year= 2011 | volume= 28 | issue= 1 | pages= 56-9 | pmid=21654988 | doi=10.4103/0970-2113.76303 | pmc=3099513 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21654988  }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref>


===History and Symptoms ===
===History and Symptoms ===


*Symptoms of chylothorax depresend on the rate of  [[chyle]] accumulation and [[etiology]]. Symptoms may include the following<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546  }} </ref>
*Symptoms of chylothorax depends on the rate of  [[chyle]] accumulation and [[etiology]]. In traumatic or surgically induced chylothorax, there is usually a [[Incubation period|latency period]] of two to ten days before symptoms become clinically evident. This is due to the restricted diet offered to critically ill or surgical patients, thereby reducing the [[Lymphatic system|lymphatic]] flow through the [[thoracic duct]].
*Symptoms may include the following<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546 }} </ref><ref name="pmid31292374">{{cite journal| author=Nagano N, Suzuki M, Tamura K, Kobayashi S, Kojima Y, Naka G | display-authors=etal| title=Refractory Chylothorax and Lymphedema Caused by Advanced Gastric Cancer. | journal=Intern Med | year= 2019 | volume= 58 | issue= 21 | pages= 3143-3148 | pmid=31292374 | doi=10.2169/internalmedicine.2351-18 | pmc=6875443 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31292374 }} </ref>
*[[Dyspnea]]
*[[Dyspnea]]
*[[Cough]]
*[[Cough]]
Line 184: Line 191:
=== Physical Examination ===
=== Physical Examination ===
*Patients with chylothorax usually appear to be in [[Respiratory failure|respiratory distress]]
*Patients with chylothorax usually appear to be in [[Respiratory failure|respiratory distress]]
*Physical examination may be remarkable for<ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref><ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>
*Physical examination may be remarkable for<ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref><ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801 }} </ref><ref name="pmid31292374">{{cite journal| author=Nagano N, Suzuki M, Tamura K, Kobayashi S, Kojima Y, Naka G | display-authors=etal| title=Refractory Chylothorax and Lymphedema Caused by Advanced Gastric Cancer. | journal=Intern Med | year= 2019 | volume= 58 | issue= 21 | pages= 3143-3148 | pmid=31292374 | doi=10.2169/internalmedicine.2351-18 | pmc=6875443 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31292374  }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref>
*Decreased [[breath sounds]] on the affected side
*Decreased [[breath sounds]] on the affected side
*[[Tachypnea]]
*[[Apnea|Apneic]] episodes
*[[Apnea|Apneic]] episodes
*[[Tachycardia]]
*[[Tachycardia]]
*[finding 4]
*[[Hypotension]]
*[finding 5]
*Enlarged [[axillary lymph nodes]]
*[finding 6]


=== Laboratory Findings ===
=== Laboratory Findings ===
*An elevated concentration of [[Pleural effusion|pleural fluid]] [[triglyceride]]  >110 mg/dL is diagnostic of chylothorax.<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref>
*An elevated concentration of [[Pleural effusion|pleural fluid]] [[triglyceride]]  >110 mg/dL is diagnostic of chylothorax.<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386 }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref>
*A reduced concentration of [[cholesterol]] <200mg/dl is diagnostic of chylothorax.<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref>
*A reduced concentration of [[cholesterol]] <200mg/dl is diagnostic of chylothorax.<ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref>
*[[Leukocyte]] cell count  ˃1000, with > 90% lymphocytic predominance.<ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>
*[[Leukocyte]] cell count  ˃1000, with > 90% lymphocytic predominance.<ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>
Line 202: Line 209:


===X-ray===
===X-ray===
*An [[Chest X-ray|x-ray]] may be helpful in the diagnosis of chylothorax. Findings on an [[Chest X-ray|x-ray]] suggestive of/diagnostic of chylothorax include.<ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref>ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546  }} </ref><ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>
*An [[Chest X-ray|x-ray]] may be helpful in the diagnosis of chylothorax. Findings on an [[Chest X-ray|x-ray]] suggestive of chylothorax include.<ref name="pmid30402386">{{cite journal| author=Benninger LA, Ross JA, Leon ME, Reddy R| title=An unusual case of chylothorax. | journal=Respir Med Case Rep | year= 2018 | volume= 25 | issue=  | pages= 318-322 | pmid=30402386 | doi=10.1016/j.rmcr.2018.10.020 | pmc=6205929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30402386  }} </ref><ref name="pmid29316546">{{cite journal| author=Rajagopala S, Kancherla R, Ramanathan RP| title=Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature. | journal=Respiration | year= 2018 | volume= 95 | issue= 4 | pages= 260-268 | pmid=29316546 | doi=10.1159/000484694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29316546  }} </ref><ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>
*[[Pleural effusion]]
*[[Pleural effusion]]
*[[Pleural]] thickening
*[[Pleural]] thickening
*Blunting of the [[Costophrenic angle]]
*Blunting of the [[Costophrenic angle]]
[[File:Xray chylothorax.png|400px|left|thumb|X-ray showing bilateral chylothorax post [[mastectomy]] (Image B). Normal preop Xray (image A) showing [[costophrenic angle]] (yellow arrowhead), Image C shows post chylothorax management and restoration of the [[costophrenic angle]] (yellow arrow) (Picture courtesy: [https://openi.nlm.nih.gov/detailedresult?img=PMC4059869_cjc-33-06-317-g001&query=chylothorax&it=xg&req=4&npos=12 National Library of Medicine])]]
<br style="clear:left">


===Ultrasound===
===Ultrasound===
Transthoracic [[ultrasound]] may be helpful in the diagnosis of chylothorax, loculated fluid collection can be seen on an [[ultrasound]]. <ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>
Transthoracic [[ultrasound]] may be helpful in the diagnosis of chylothorax. Finding loculated fluid collection is suggestive of chylothorax. <ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref>


===CT scan===
===CT scan===
Thoracic [[Computed tomography|CT scan]] may be helpful in the diagnosis of chylothorax. Findings on [[Computed tomography|CT scan]] suggestive of/diagnostic of  chylothorax include<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref>
Thoracic [[Computed tomography|CT scan]] may be helpful in the diagnosis of chylothorax.[[Computed tomography|CT scan]] is valuable in the location and treatment decision of chylothorax Findings on [[Computed tomography|CT scan]] suggestive of chylothorax include<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref> [[pleural effusion]]
*[[Pleural effusion]]
 
[[File:CT Chylothorax.gif|400px|left|thumb|Non-contrast [[computerized tomography|CT]] showing [[chyle]] collection. (Picture courtesy: [https://openi.nlm.nih.gov/detailedresult?img=PMC3904686_1749-8090-9-8-1&query=chylothorax&it=xg&req=4&npos=4 National Library of Medicine])]]
<br style="clear:left">


===MRI===
===MRI===
*There are no MRI findings associated with chylothorax.


===Other Imaging Findings===
===Other Imaging Findings===
Other diagnostic studies for chylothorax include  
Other diagnostic studies for chylothorax include  
*[[Lymphangiography]] with [[Lipiodol]] ([[ethiodized oil]])  <ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref> which demonstrates the site of extravasation into the [[pleural cavity]].
*[[Lymphangiography]] with [[Lipiodol]] ([[ethiodized oil]])  <ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref> which demonstrates the site of extravasation into the [[pleural cavity]].
*lymphoscintigraphy; identify [[chyle]] leakage but not the exact site.<ref name="pmid29106894">{{cite journal| author=Nicastri DG, Flores RM| title=Chylothorax: Abdominal approach. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 2 | pages= 814 | pmid=29106894 | doi=10.1016/j.jtcvs.2017.09.111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29106894  }} </ref><ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref><ref name="pmid29438003">{{cite journal| author=Turpin S, Lambert R| title=Lymphoscintigraphy of Chylous Anomalies: Chylothorax, Chyloperitoneum, Chyluria, and Lymphangiomatosis-15-Year Experience in a Pediatric Setting and Review of the Literature. | journal=J Nucl Med Technol | year= 2018 | volume= 46 | issue= 2 | pages= 123-128 | pmid=29438003 | doi=10.2967/jnmt.117.203281 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29438003  }} </ref>
*lymphoscintigraphy; identify [[chyle]] leakage but not the exact site.<ref name="pmid29106894">{{cite journal| author=Nicastri DG, Flores RM| title=Chylothorax: Abdominal approach. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 2 | pages= 814 | pmid=29106894 | doi=10.1016/j.jtcvs.2017.09.111 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29106894  }} </ref><ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref><ref name="pmid29438003">{{cite journal| author=Turpin S, Lambert R| title=Lymphoscintigraphy of Chylous Anomalies: Chylothorax, Chyloperitoneum, Chyluria, and Lymphangiomatosis-15-Year Experience in a Pediatric Setting and Review of the Literature. | journal=J Nucl Med Technol | year= 2018 | volume= 46 | issue= 2 | pages= 123-128 | pmid=29438003 | doi=10.2967/jnmt.117.203281 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29438003 }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref>


=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
Line 227: Line 239:
=== Medical Therapy ===
=== Medical Therapy ===
Chylothorax is a medical emergency and requires prompt treatment.  
Chylothorax is a medical emergency and requires prompt treatment.  
Medical therapy for chylothorax include<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref> Conservative therapy aims at minimizing [[Lymphatic system|lymph flow]] through the damaged [[thoracic duct]].<ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref><ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref><ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages= | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801 }} </ref>
Medical therapy for chylothorax include<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref><ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref> Conservative therapy aims at minimizing [[Lymphatic system|lymph flow]] through the damaged [[thoracic duct]].<ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref><ref name="pmid29703801">{{cite journal| author=Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY| title=Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients. | journal=Pediatrics | year= 2018 | volume= 141 | issue= 5 | pages=  | pmid=29703801 | doi=10.1542/peds.2016-3309 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29703801  }} </ref><ref name="pmid19882503">{{cite journal| author=Waterfield T, Lakhoo K| title=Challenges in the management of refractory bilateral idiopathic congenital chylothoraces in a newborn. | journal=Eur J Pediatr Surg | year= 2010 | volume= 20 | issue= 3 | pages= 198-201 | pmid=19882503 | doi=10.1055/s-0029-1241874 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19882503  }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue= | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref>
*[[Total parenteral nutrition]]
*[[Total parenteral nutrition]] with oral fasting
*Oral low-fat medium-chain [[triglyceride]]
*Oral low-fat medium-chain [[triglyceride]]
*[[Octreotide injection]]s
*[[Octreotide injection]]s
*Treatment of the underlying condition
*Treatment of the underlying condition
**[[Sarcoidosis]] with [[steroid]]s  
**[[Sarcoidosis]] with [[steroid]]s  
**[[Tuberculosis]] with [[Tuberculosis medical therapy|RIPE]]
**[[Congestive heart failure]] with [[diuretic]]s
**[[Congestive heart failure]] with [[diuretic]]s
*Intravenous [[etilefrine]]
*Intravenous [[etilefrine]]


=== Surgery ===
=== Surgery ===
Surgery is the mainstay of therapy for chylothorax. Surgery is recommended  where despite conservative management, patient drains more than 1.5 l/day in an adult or >100 ml/kg body weight per day in a child, leaks [[chyle]] at  >1 l/day× 5 days or has persistent [[chyle]] flow for >2 weeks. It is also recommended if there is a rapid decline in nutritional status despite conservative management.<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref> <ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473  }} </ref><ref name="pmid29249497">{{cite journal| author=Lo Rito M, Al-Radi OO, Saedi A, Kotani Y, Ben Sivarajan V, Russell JL | display-authors=etal| title=Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 5 | pages= 2069-2077 | pmid=29249497 | doi=10.1016/j.jtcvs.2017.11.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29249497  }} </ref><ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref><ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref><ref name="pmid17251600">{{cite journal| author=Townshend AP, Speake W, Brooks A| title=Chylothorax. | journal=Emerg Med J | year= 2007 | volume= 24 | issue= 2 | pages= e11 | pmid=17251600 | doi=10.1136/emj.2006.042028 | pmc=2658219 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17251600  }} </ref>
Surgery is the mainstay of therapy for chylothorax. Surgery is recommended  where despite conservative management, patient drains more than 1.5 l/day in an adult or >100 ml/kg body weight per day in a child, leaks [[chyle]] at  >1 l/day× 5 days or has persistent [[chyle]] flow for >2 weeks. It is also recommended if there is a rapid decline in nutritional status despite conservative management.<ref name="pmid30474568">{{cite journal| author=Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S| title=Chylothorax after hepatectomy: a case report. | journal=J Med Case Rep | year= 2018 | volume= 12 | issue= 1 | pages= 347 | pmid=30474568 | doi=10.1186/s13256-018-1882-x | pmc=6260677 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30474568  }} </ref> <ref name="pmid19766473">{{cite journal| author=McGrath EE, Blades Z, Anderson PB| title=Chylothorax: aetiology, diagnosis and therapeutic options. | journal=Respir Med | year= 2010 | volume= 104 | issue= 1 | pages= 1-8 | pmid=19766473 | doi=10.1016/j.rmed.2009.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19766473 }} </ref><ref name="pmid17273624">{{cite journal| author=Vaz MA, Fernandes PP| title=[Chylothorax]. | journal=J Bras Pneumol | year= 2006 | volume= 32 Suppl 4 | issue=  | pages= S197-203 | pmid=17273624 | doi=10.1590/s1806-37132006000900006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17273624 }} </ref><ref name="pmid29249497">{{cite journal| author=Lo Rito M, Al-Radi OO, Saedi A, Kotani Y, Ben Sivarajan V, Russell JL | display-authors=etal| title=Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 5 | pages= 2069-2077 | pmid=29249497 | doi=10.1016/j.jtcvs.2017.11.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29249497  }} </ref><ref name="pmid28494978">{{cite journal| author=Savla JJ, Itkin M, Rossano JW, Dori Y| title=Post-Operative Chylothorax in Patients With Congenital Heart Disease. | journal=J Am Coll Cardiol | year= 2017 | volume= 69 | issue= 19 | pages= 2410-2422 | pmid=28494978 | doi=10.1016/j.jacc.2017.03.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28494978  }} </ref><ref name="pmid25829744">{{cite journal| author=Das J, Thambudorai R, Ray S| title=Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax. | journal=Indian J Nucl Med | year= 2015 | volume= 30 | issue= 2 | pages= 177-9 | pmid=25829744 | doi=10.4103/0972-3919.152988 | pmc=4379685 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25829744  }} </ref><ref name="pmid17251600">{{cite journal| author=Townshend AP, Speake W, Brooks A| title=Chylothorax. | journal=Emerg Med J | year= 2007 | volume= 24 | issue= 2 | pages= e11 | pmid=17251600 | doi=10.1136/emj.2006.042028 | pmc=2658219 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17251600 }} </ref><ref name="pmid19882503">{{cite journal| author=Waterfield T, Lakhoo K| title=Challenges in the management of refractory bilateral idiopathic congenital chylothoraces in a newborn. | journal=Eur J Pediatr Surg | year= 2010 | volume= 20 | issue= 3 | pages= 198-201 | pmid=19882503 | doi=10.1055/s-0029-1241874 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19882503  }} </ref><ref name="pmid31341753">{{cite journal| author=Jacob S, Meneses A, Landolfo K, El-Sayed Ahmed M, Makey IA, Pham SM | display-authors=etal| title=Incidence, Management, and Outcomes of Chylothorax after Lung Transplantation: A Single-center Experience. | journal=Cureus | year= 2019 | volume= 11 | issue= 7 | pages= e5190 | pmid=31341753 | doi=10.7759/cureus.5190 | pmc=6649881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31341753  }} </ref><ref name="pmid29129424">{{cite journal| author=Diaz-Gutierrez I, Rao MV, Andrade RS| title=Laparoscopic ligation of cisterna chyli for refractory chylothorax: A case series and review of the literature. | journal=J Thorac Cardiovasc Surg | year= 2018 | volume= 155 | issue= 2 | pages= 815-819 | pmid=29129424 | doi=10.1016/j.jtcvs.2017.08.140 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29129424 }} </ref>
*[[Thoracentesis]]
*[[Thoracentesis]]
*[[Chest tube|Tube thoracostomy]]
*[[Chest tube|Tube thoracostomy]]
Line 249: Line 262:
*pleuroperitoneal shunt  
*pleuroperitoneal shunt  
*[[Thoracic duct]] ligation
*[[Thoracic duct]] ligation
*Ligation of [[cisterna chyli]]
*Lymphatic [[Therapeutic embolization|embolization]]
*Lymphatic [[Therapeutic embolization|embolization]]


Latest revision as of 02:02, 31 July 2020

Chylothorax
ICD-10 I89.8, J91
ICD-9 457.8, 511.9
DiseasesDB 29612
eMedicine med/381 
MeSH D002916

WikiDoc Resources for Chylothorax

Articles

Most recent articles on Chylothorax

Most cited articles on Chylothorax

Review articles on Chylothorax

Articles on Chylothorax in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Chylothorax

Images of Chylothorax

Photos of Chylothorax

Podcasts & MP3s on Chylothorax

Videos on Chylothorax

Evidence Based Medicine

Cochrane Collaboration on Chylothorax

Bandolier on Chylothorax

TRIP on Chylothorax

Clinical Trials

Ongoing Trials on Chylothorax at Clinical Trials.gov

Trial results on Chylothorax

Clinical Trials on Chylothorax at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Chylothorax

NICE Guidance on Chylothorax

NHS PRODIGY Guidance

FDA on Chylothorax

CDC on Chylothorax

Books

Books on Chylothorax

News

Chylothorax in the news

Be alerted to news on Chylothorax

News trends on Chylothorax

Commentary

Blogs on Chylothorax

Definitions

Definitions of Chylothorax

Patient Resources / Community

Patient resources on Chylothorax

Discussion groups on Chylothorax

Patient Handouts on Chylothorax

Directions to Hospitals Treating Chylothorax

Risk calculators and risk factors for Chylothorax

Healthcare Provider Resources

Symptoms of Chylothorax

Causes & Risk Factors for Chylothorax

Diagnostic studies for Chylothorax

Treatment of Chylothorax

Continuing Medical Education (CME)

CME Programs on Chylothorax

International

Chylothorax en Espanol

Chylothorax en Francais

Business

Chylothorax in the Marketplace

Patents on Chylothorax

Experimental / Informatics

List of terms related to Chylothorax

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor: Joanna Ekabua, M.D. [2]

Synonyms and keywords: Chylothorax

Overview

Chylothorax, a type of pleural effusion is the accumulation of chyle in the pleural cavity secondary to destruction or obstruction of the thoracic duct or its tributaries. Depending on the etiology, chylothorax could be exudative ( tuberculosis) or transudative (svc obstruction). It is an uncommon but established complication of thoracic surgery. Chylothorax is most commonly right-sided (50%) because of the anatomic location of the thoracic duct, left-sided (33.3%), or bilateral (16.66%). Thoracic duct damage above the fifth thoracic vertebra results in a left-sided chylothorax whereas damage to the thoracic duct below fifth thoracic vertebra leads to a right-sided effusion. Some common symptoms of chylothorax include dyspnea, cough, and severe chest pain. Some physical exams finding include decreased breath sounds and dullness to percussion depending on the size and location of fluid. The definitive diagnosis of chylothorax is with thoracentesis and analysis of the pleural fluid showing a reduced concentration of cholesterol <200mg/dl, and an elevated concentration of triglyceride >110 mg/dl. Management of chylothorax may be conservative or surgical. Conservative management include total parenteral nutrition, oral low-fat medium-chain triglyceride, and octreotide injections. Surgical management include tube thoracostomy, pleurodesis, pleurectomy, pleuroperitoneal shunt, and thoracic duct ligation.

Historical Perspective

  • Chylothorax was first described in 1633 by Bartolet, and Quincke reported the first case in 1875. [1]
  • In 1917, Brandt was the first to discover the association between tuberculosis and the development of chylothorax. [1]

Classification

Chylothorax may be classified as[2][3]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chylothorax
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-traumatic
 
 
 
 
 
 
 
 
 
 
 
Traumatic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Malignancy
 
Diseases
 
Idopathic
 
 
 
Non- Iatrogenic
 
 
 
 
 
Iatrogenic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
- Sarcoidosis

- Haemangiomatosis

- Tuberculosis

- Heart failure

-Benign tumor

- Amyloidosis

-Lymphangiolei -omyomatosis

- Filariasis

- Transdiaphrgmatic movement of chylous ascitic fluid

- SVC obstruction
 
 
 
 
 
 
 
- Knife injury

- Childbirth

- Forceful cough or emesis

- Blunt trauma to the thorax

- Bullet wound
 
 
 
 
 
- Radiation

- Thoracic surgery

- Head and neck surgery
 
 
 
 
 
 

Pathophysiology

Causes

Differentiating chylothorax from other Diseasess

Chylothorax must be differentiated from[3] [8] [9][4]

Epidemiology and Demographics

  • The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
  • In 2011, the incidence of pediatric chylothorax was estimated to be 3.7%[10] [11]
  • Incidence post cardiothoracic surgeries are between 0.9% and 6.6%.
  • Incidence post esophageal surgeries range from 0.2% to 10%.

Age

  • Patients of all age groups may develop chylothorax.[11][10]

Gender

  • Chylothorax affects men and women equally.

Race

  • There is no racial predilection for chylothorax.

Risk Factors

Common risk factors in the development of Chylothorax] are[2][3][12][13][10][14][15][16][17][5][18][19]

Screening

  • There is insufficient evidence to recommend routine screening for chylothorax.

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

  • There are no ECG findings associated with chylothorax.

X-ray

X-ray showing bilateral chylothorax post mastectomy (Image B). Normal preop Xray (image A) showing costophrenic angle (yellow arrowhead), Image C shows post chylothorax management and restoration of the costophrenic angle (yellow arrow) (Picture courtesy: National Library of Medicine)


Ultrasound

Transthoracic ultrasound may be helpful in the diagnosis of chylothorax. Finding loculated fluid collection is suggestive of chylothorax. [11]

CT scan

Thoracic CT scan may be helpful in the diagnosis of chylothorax.CT scan is valuable in the location and treatment decision of chylothorax Findings on CT scan suggestive of chylothorax include[2] pleural effusion

Non-contrast CT showing chyle collection. (Picture courtesy: National Library of Medicine)


MRI

  • There are no MRI findings associated with chylothorax.

Other Imaging Findings

Other diagnostic studies for chylothorax include

Other Diagnostic Studies

  • There are no other diagnostic studies associated with chylothorax.

Treatment

Medical Therapy

Chylothorax is a medical emergency and requires prompt treatment. Medical therapy for chylothorax include[2][3][10] Conservative therapy aims at minimizing lymph flow through the damaged thoracic duct.[20][11][6][4]

Surgery

Surgery is the mainstay of therapy for chylothorax. Surgery is recommended where despite conservative management, patient drains more than 1.5 l/day in an adult or >100 ml/kg body weight per day in a child, leaks chyle at >1 l/day× 5 days or has persistent chyle flow for >2 weeks. It is also recommended if there is a rapid decline in nutritional status despite conservative management.[2] [3][4][12][10][20][15][6][18][22]

Primary Prevention

  • There are no established measures for the primary prevention of chylothorax.

Secondary Prevention

  • There are no established measures for the secondary prevention of chylothorax.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Kant S, Verma SK, Anand SC, Prasad R, Verma RK (2011). "Development of bilateral chylothorax in a younger female secondary to tuberculosis". Lung India. 28 (1): 56–9. doi:10.4103/0970-2113.76303. PMC 3099513. PMID 21654988.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S (2018). "Chylothorax after hepatectomy: a case report". J Med Case Rep. 12 (1): 347. doi:10.1186/s13256-018-1882-x. PMC 6260677. PMID 30474568.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 McGrath EE, Blades Z, Anderson PB (2010). "Chylothorax: aetiology, diagnosis and therapeutic options". Respir Med. 104 (1): 1–8. doi:10.1016/j.rmed.2009.08.010. PMID 19766473.
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 Vaz MA, Fernandes PP (2006). "[Chylothorax]". J Bras Pneumol. 32 Suppl 4: S197–203. doi:10.1590/s1806-37132006000900006. PMID 17273624.
  5. ↑ 5.0 5.1 5.2 5.3 Rajagopala S, Kancherla R, Ramanathan RP (2018). "Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature". Respiration. 95 (4): 260–268. doi:10.1159/000484694. PMID 29316546.
  6. ↑ 6.0 6.1 6.2 Waterfield T, Lakhoo K (2010). "Challenges in the management of refractory bilateral idiopathic congenital chylothoraces in a newborn". Eur J Pediatr Surg. 20 (3): 198–201. doi:10.1055/s-0029-1241874. PMID 19882503.
  7. ↑ Austin A, Al-Faris F, Modi A, Chopra A (2019). "A transudative chylothorax associated with superior vena cava syndrome". Respir Med Case Rep. 28: 100898. doi:10.1016/j.rmcr.2019.100898. PMC 6626116 Check |pmc= value (help). PMID 31338288.
  8. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  9. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Savla JJ, Itkin M, Rossano JW, Dori Y (2017). "Post-Operative Chylothorax in Patients With Congenital Heart Disease". J Am Coll Cardiol. 69 (19): 2410–2422. doi:10.1016/j.jacc.2017.03.021. PMID 28494978.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Muniz G, Hidalgo-Campos J, Valdivia-Tapia MDC, Shaikh N, Carreazo NY (2018). "Successful Management of Chylothorax With Etilefrine: Case Report in 2 Pediatric Patients". Pediatrics. 141 (5). doi:10.1542/peds.2016-3309. PMID 29703801.
  12. ↑ 12.0 12.1 Lo Rito M, Al-Radi OO, Saedi A, Kotani Y, Ben Sivarajan V, Russell JL; et al. (2018). "Chylothorax and pleural effusion in contemporary extracardiac fenestrated fontan completion". J Thorac Cardiovasc Surg. 155 (5): 2069–2077. doi:10.1016/j.jtcvs.2017.11.046. PMID 29249497.
  13. ↑ Sasaki H, Kimizuka Y, Ogata H, Okada Y, Ota S, Sano T; et al. (2019). "Successful Control of Dasatinib-related Chylothorax by the Japanese Herbal Medicine "Goreisan"". Intern Med. 58 (21): 3139–3141. doi:10.2169/internalmedicine.3002-19. PMC 6875454 Check |pmc= value (help). PMID 31292394.
  14. ↑ 14.0 14.1 14.2 Nicastri DG, Flores RM (2018). "Chylothorax: Abdominal approach". J Thorac Cardiovasc Surg. 155 (2): 814. doi:10.1016/j.jtcvs.2017.09.111. PMID 29106894.
  15. ↑ 15.0 15.1 Townshend AP, Speake W, Brooks A (2007). "Chylothorax". Emerg Med J. 24 (2): e11. doi:10.1136/emj.2006.042028. PMC 2658219. PMID 17251600.
  16. ↑ 16.0 16.1 16.2 16.3 16.4 Benninger LA, Ross JA, Leon ME, Reddy R (2018). "An unusual case of chylothorax". Respir Med Case Rep. 25: 318–322. doi:10.1016/j.rmcr.2018.10.020. PMC 6205929. PMID 30402386.
  17. ↑ Pospiskova J, Smolej L, Belada D, Simkovic M, Motyckova M, Sykorova A; et al. (2019). "Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders". Orphanet J Rare Dis. 14 (1): 9. doi:10.1186/s13023-018-0991-3. PMC 6327395. PMID 30626415.
  18. ↑ 18.0 18.1 Jacob S, Meneses A, Landolfo K, El-Sayed Ahmed M, Makey IA, Pham SM; et al. (2019). "Incidence, Management, and Outcomes of Chylothorax after Lung Transplantation: A Single-center Experience". Cureus. 11 (7): e5190. doi:10.7759/cureus.5190. PMC 6649881 Check |pmc= value (help). PMID 31341753.
  19. ↑ 19.0 19.1 19.2 Nagano N, Suzuki M, Tamura K, Kobayashi S, Kojima Y, Naka G; et al. (2019). "Refractory Chylothorax and Lymphedema Caused by Advanced Gastric Cancer". Intern Med. 58 (21): 3143–3148. doi:10.2169/internalmedicine.2351-18. PMC 6875443 Check |pmc= value (help). PMID 31292374.
  20. ↑ 20.0 20.1 20.2 20.3 Das J, Thambudorai R, Ray S (2015). "Lymphoscintigraphy combined with single-photon emission computed tomography-computed tomography (SPECT-CT): A very effective imaging approach for identification of the site of leak in postoperative chylothorax". Indian J Nucl Med. 30 (2): 177–9. doi:10.4103/0972-3919.152988. PMC 4379685. PMID 25829744.
  21. ↑ Turpin S, Lambert R (2018). "Lymphoscintigraphy of Chylous Anomalies: Chylothorax, Chyloperitoneum, Chyluria, and Lymphangiomatosis-15-Year Experience in a Pediatric Setting and Review of the Literature". J Nucl Med Technol. 46 (2): 123–128. doi:10.2967/jnmt.117.203281. PMID 29438003.
  22. ↑ Diaz-Gutierrez I, Rao MV, Andrade RS (2018). "Laparoscopic ligation of cisterna chyli for refractory chylothorax: A case series and review of the literature". J Thorac Cardiovasc Surg. 155 (2): 815–819. doi:10.1016/j.jtcvs.2017.08.140. PMID 29129424.

Template:Vascular diseases Template:Respiratory pathology

de:Chylothorax nl:Chylothorax

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Chylothorax&oldid=1645414"