Chylothorax

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

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List of terms related to 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.

Classification

Chylothorax may be classified as

• Nontraumatic
• Traumatic

Causes

Its cause is usually leakage from the thoracic duct or one of the main lymphatic vessels that drain to it. The most common causes are lymphoma and trauma caused by thoracic surgery. The effusion is characteristically white and milky in appearance and contains high levels of triglycerides.

In animals, chylothorax usually results from diseases that cause obstruction to the thoracic duct preventing lymph from draining normally into the venous system. Examples include tumors, heartworm disease, right sided cardiac failure, or idiopathic lymphangiectasia. The most effective form of treatment is surgical ligation of the thoracic duct combined with partial pericardectomy.

Differentiating chylothorax from other Diseasess

• Cirrhosis
• Congenital chylothorax
• Filariasis
• Iatrogenic
• Idiopathic
• Lymphoma
• Nonlymphomatous malignancies
• Nonsurgical penetrating trauma
• Tuberculosis

Epidemiology and Demographics

• The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
• In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

• Patients of all age groups may develop [disease name].

• [Disease name] is more commonly observed among patients aged [age range] years old.
• [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

• [Disease name] 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

• There is no racial predilection for [disease name].

• [Disease name] usually affects individuals of the [race 1] race.
• [Race 2] individuals are less likely to develop [disease name].

Risk Factors

Common risk factors in the development of Chylothorax] are

• Hepatectomy
• Esophagectomy
• Lung surgery
• Cardiac surgery
• Retroperitoneal surgery around the cisterna chyli, example abdominal aortic aneurysm surgery

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Study of Choice

• The diagnosis of chylothorax is based on an elevated concentration of pleural fluid triglyceride >110 mg/dL.

History and Symptoms

• Symptoms of chylothorax may include the following
• Dyspnea
• Immunodeficiency
• Malnutrition

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• An elevated concentration of pleural fluid triglyceride >110 mg/dL is diagnostic of chylothorax.

CT scan

Thoracic CT scan may be helpful in the diagnosis of chylothorax. Findings on CT scan suggestive of/diagnostic of chylothorax include

• Pleural effusion

Other Imaging Findings

Other diagnostic studies for chylothorax include

• Lymphangiography with Lipiodol (ethiodized oil) which demonstrates extravasation into the pleural space.

Other Diagnostic Studies

• [Disease name] may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

Chylothorax is a medical emergency and requires prompt treatment. Medical therapy for chylothorax include

• Total parenteral nutrition
• Octreotide injections

Surgery

Surgery is the mainstay of therapy for chylothorax

• Thoracentesis
• Tube thoracostomy
• Thoracoscopy
• Pleurodesis

Primary Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

See also

• Pleural effusion