A contemporary review of chylothorax

This review will focus on anatomical and aetiologic factors as well as the conservative and operative therapy of chylothorax.

A Pubmed search for studies pertaining to the aetiology and/or treatment published in the English language from 1960 to 2007.

Studies presenting case reports, series, observational and/or retrospective studies, and those with unique issues pertaining to chylothorax were reviewed independantly by both authors. Studies that were selected by both authors contain most clinically relevant data.

Chylothorax is caused by injury or obstruction of the thoracic duct or its main tributaries leading to chyle accumulation in the pleural space. It most commonly occurs from trauma or malignancy, but other causes have been described. Although chylous effusions are rare, they have serious clinical consequences including cachexia and immunodeficiency. There are no evidence-based guidelines to assist in the management of this disease.

A prompt diagnosis is needed to start treatment of the underlying cause. Treatment can be divided into conservative and surgical interventions. There are no evidence-based guidelines to assist in the management of this disease. Initial conservative therapy includes intercostal decompression of the pleural effusion along with nutritional support in the form of total parenteral nutrition, and reduction of chylous formation with somatostatin. Surgical interventions include thoracic duct ligation, pleuroperitoneal shunt and percutaneous embolisation.