The changing management of chylothorax in the modern era.
Initial conservative therapy is applied to all cases of chylothorax (CTx) with expected excellent outcomes. The indication for aggressive surgical treatment of early CTx remains uncertain and requires rigorous scientific scrutiny. Lymphangiography and lymphoscintigraphy are useful to localize the leak and assess thoracic duct patency as well as to differentiate partial from complete thoracic duct transection. The aetiology of the CTx, flow rate and patient condition dictate the preferred management. Octreotide/somatostatin and etilefrine therapy is highly efficacious in the conservative management of CTx. For patients in whom conservative management fails, those who are good surgical candidates, and those in whom the site of the leak is well identified, surgical repair and/or ligation using minimally invasive techniques is highly successful with limited adverse outcomes. Similarly, if the site of the chylous effusion cannot be well visualized, a thoracic duct ligation via video-assisted thoracic surgery is the gold standard approach. A pleuroperitoneal or less often a pleurovenous shunt is a final option and may be curative in some patients.
Saint George's University School of Medicine, Grenada Department of Internal Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.
Bradley
B
Bender
Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA.
Vijayashree
V
Murthy
Saint George's University School of Medicine, Grenada Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA Department of Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA rchamberlain@barnabashealth.org.
Ronald S
RS
Chamberlain
D002916:Chylothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D019468:Disease Management; D004322:Drainage / Q000379:methods*; D005260:Female; D005544:Forecasting; D006801:Humans; D008026:Ligation / Q000379:methods; D008220:Lymphography / Q000379:methods; D008297:Male; D015282:Octreotide / Q000627:therapeutic use; D018700:Pleurodesis / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods; D012720:Severity of Illness Index; D013004:Somatostatin / Q000627:therapeutic use; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods
D013004:Somatostatin; D015282:Octreotide
Chylothorax; Chylothorax management; Chylous leak; Iatrogenic chylothorax; Postoperative chylothorax; Traumatic chylothorax