title: Therapeutic strategies for idiopathic chylothorax.
abstract: OBJECTIVE
  The objectives of the study were to present our institutional experience of idiopathic chylothorax in children and to propose therapeutic strategies.
  
  
  METHODS
  This was a retrospective, single-center study.
  
  
  METHODS
  Patients were 6 children (4 boys, 2 girls) presenting with an idiopathic chylothorax diagnosed from the presence of a chylous pleural effusion with triglycerides greater than 1.2 mmol/L and a cellularity greater than 1000 cells/mL with a predominance of lymphocytes.
  
  
  RESULTS
  Median age of onset was 7 years (range, 2-14 years). Initial symptoms included cough (n = 4), tachypnea (n = 4), asthenia (n = 5), abdominal pain (n = 2), and bronchitis (n = 1). Chest radiography showed 2 left, 2 right, and 2 bilateral pleural effusions. Serum biology assessment was normal in all children. Respiratory function assessment at diagnosis revealed a decrease in functional residual capacity in 3 children and a decrease in lung diffusing capacity in 2 children. Initially, all patients received a medium-chain triglyceride diet for 29 months (range, 10-50 months). Total parenteral nutrition was required for 4 patients (for 1-4 months), and somatostatin was tried in one child. Two children required pleuroperitoneal shunting, bilateral in one case. During the follow-up (median duration, 6 years; range, 2-16 years), chylothorax stabilized in all patients and 5 patients were able to return to a normal diet.
  
  
  CONCLUSIONS
  A medium-chain triglyceride diet associated in some cases with total parenteral nutrition may stabilize idiopathic chylothorax in children. In cases where conservative treatment has failed, pleuroperitoneal shunting may be useful.
authors: Hôpital Armand Trousseau, Université Pierre et Marie Curie-Paris 6, Paris, France. ralph.epaud@trs.aphp.fr
authors: Ralph
authors: R
authors: Epaud
authors: Beatrice
authors: B
authors: Dubern
authors: Michele
authors: M
authors: Larroquet
authors: Aline
authors: A
authors: Tamalet
authors: Nathalie
authors: N
authors: Guillemot
authors: Chantal
authors: C
authors: Maurage
authors: Annick
authors: A
authors: Clement
authors: Brigitte
authors: B
authors: Fauroux
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D018752:Diet, Fat-Restricted; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods; D010996:Pleural Effusion / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome