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Management of nontraumatic chylothorax
The Annals of Thoracic Surgery
|June 1, 1981
Summary
Chylothorax, the accumulation of chyle in the pleural space, often requires intervention. Early surgical treatment, including thoracotomy, offers significant palliation for nontraumatic chylothorax when nonoperative methods fail.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Gastroenterology
Background:
- Chylothorax is a rare condition involving lymphatic fluid in the pleural space.
- It can be traumatic (post-operative) or nontraumatic.
- Nontraumatic chylothorax is associated with conditions like lymphoma and systemic lupus erythematosus.
Observation:
- This study reviewed 22 patients with chylothorax treated at the National Institutes of Health.
- 13 patients had nontraumatic chylothorax, 6 with tumors (lymphoma) and 7 without.
- Chylous ascites was common in both groups with nontraumatic chylothorax.
Findings:
- Nonoperative therapy provided only temporary relief in 3 of 13 nontraumatic cases.
- Steroid therapy was effective in one patient with systemic lupus erythematosus.
- Thoracotomy resulted in permanent relief for 3 of 4 patients with nontraumatic chylothorax.
Implications:
- Thoracotomy with thoracic duct ligation/pleurectomy/pleurodesis offers substantial palliation for nontraumatic chylothorax.
- Surgery is recommended even when lymph leakage is not localized or ascites is present.
- Early surgical intervention is advocated for nontraumatic chylothorax in the absence of medically treatable conditions.