title: The role for tunneled indwelling pleural catheters in patients with persistent benign chylothorax.
abstract: BACKGROUND
  Utilization of tunneled indwelling pleural catheters (TIPCs) for persistent pleural effusions is increasingly more common; however, the presence of chylothorax is generally considered a contraindication for utilization of a TIPC due to concerns regarding potential nutritional, immunologic and hemodynamic complications. Therefore, in this study, a cohort of patients with persistent benign chylothorax managed with TIPCs is described.
  
  
  METHODS
  A retrospective analysis of patients with persistent benign chylothorax managed with a TIPC at the study center between January 1, 2008, and March 1, 2012, was completed. Extracted data included patient characteristics, chylothorax etiologies, prior interventions, outcomes and complications.
  
  
  RESULTS
  Eleven patients (14 hemithoraces) had persistent benign chylothorax treated with placement of a TIPC during the inclusion time frame. Etiology of the chylothorax was nontraumatic in 8 of the 11 patients, with the remaining 3 secondary to thoracic surgery. Pleurodesis was achieved in 9 of the 14 hemithoraces, with a median time to pleurodesis of 176 days. All procedures were well tolerated, and no immediate periprocedural complications were reported. One serious complication was encountered in the form of a postoperative pulmonary embolism after replacement of an occluded TIPC, resulting in the patient's death. Two patients had transient occlusions of their TIPCs successfully treated with intracatheter thrombolytic therapy. No significant adverse nutritional, hemodynamic or immunologic outcomes were reported during follow-up for any included patient.
  
  
  CONCLUSIONS
  Utilization of a TIPC for the management of persistent benign chylothorax should be considered early because pleurodesis may be frequently and safely achieved in this patient population.
authors: Division of Pulmonary and Critical Care Medicine (ZSD, SI, JJM, FM), and Division of Thoracic Surgery (FCN), Mayo Clinic, Rochester, Minnesota.
authors: Zachary S
authors: ZS
authors: DePew
authors: Seher
authors: S
authors: Iqbal
authors: John J
authors: JJ
authors: Mullon
authors: Francis C
authors: FC
authors: Nichols
authors: Fabien
authors: F
authors: Maldonado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000628:therapy*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D035422:Pleural Cavity / Q000000981:diagnostic imaging; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D016896:Treatment Outcome