[Idiopathic chylothorax in dogs and cats - Anatomical foundations, pathogenesis, and therapeutic options]

Idiopathic chylothorax is a rare condition in small animals with a largely unknown etiology. In dogs, several recent studies have reported high surgical success rates, whereas the prognosis in cats remains unfavorable. The aim of this article is to develop an integrative understanding of the disease by systematically integrating anatomical, pathophysiological, physical, and clinical perspectives. Available conservative and surgical treatment strategies are evaluated with regard to success rates, complications, and prognostic relevance. Particular emphasis is placed on identifying which therapeutic decisions can be reasonably supported in clinical practice despite limited evidence and which prevailing assumptions warrant critical reassessment. A delayed surgical approach, in particular, appears to represent a potential negative aspect in current treatment concepts. The commonly standardized practice of performing thoracic duct ligation at a caudal thoracic level is also reconsidered in light of anatomical and pathophysiological findings. Furthermore, the current literature provides no clear recommendation regarding the indication for cisterna chyli ablation, and there is increasing divergence of opinion on the role of pericardectomy. The insights presented here generate concrete impulses for further research and support a more differentiated basis for clinical decision-making.