Chylothorax in thoracic oncology: diagnostic challenges and management strategies

Chylothorax is a distinctive form of pleural effusion characterized by the accumulation of chyle within the pleural space. We conducted an analysis of published evidence concerning oncological chylothorax, encompassing complications following thoracic surgery or spontaneous occurrences directly linked to thoracic malignancies. Diagnosis can be established based on clinical features of the pleural effusion and through analysis of pleural fluid. The presence of chylomicrons, measured by lipoprotein electrophoresis, triglyceride levels, and cholesterol content are indicative factors. In cases of spontaneous chylothorax, the identification of pleural effusion on CT scans showing suspicious oncological masses, such as lymphomas, prompts pleural drainage for confirmation of chylothorax. Conversely, post-surgical chylothorax diagnoses are immediate due to the pre-existing pleural drainage. In our last 10 years of experience, we have had only 18 cases of chylothorax: 28% underwent successful redo-surgery and 72% were conservatively treated. All the patients recovered well, and none experienced life-threatening situations. Conservative approaches involve hypo/alipidic diets, total parenteral nutrition, and pharmacological interventions. In persistent and challenging cases of chylothorax where drainage output is excessive, redo-surgery is recommended.