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Chylothorax and pseudochylothorax

G Hillerdal

    The European Respiratory Journal
    |May 1, 1997
    PubMed
    Summary
    This summary is machine-generated.

    Chylothorax, a lymphatic fluid buildup in the pleura, results from thoracic duct damage. Treatment involves dietary changes, nutritional support, or surgical intervention to manage this condition.

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    Area of Science:

    • Thoracic Medicine
    • Gastroenterology
    • Surgical Pathology

    Background:

    • Chylothorax involves lymphatic fluid (chylus) accumulation in the pleural space due to thoracic duct injury.
    • This condition is characterized by high triglyceride and chylomicron content in the pleural fluid.
    • It is typically right-sided but can occur on the left if the thoracic duct is damaged near the aorta.

    Purpose of the Study:

    • To elucidate the pathophysiology, diagnosis, and management of chylothorax.
    • To differentiate chylothorax from pseudochylothorax (cholesterol pleurisy).

    Main Methods:

    • Diagnostic imaging, including computed tomography (CT) scans of the thorax and upper abdomen.
    • Lymphography to identify the site of leakage or obstruction.

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  • Analysis of pleural fluid composition (triglycerides, chylomicrons, cholesterol).

    • Main Results:

    • Traumatic causes include accidents and surgery; non-traumatic causes are often linked to malignant lymphoma.
    • Repeated drainage leads to significant loss of fats, proteins, and lymphocytes.
    • Pseudochylothorax presents with high cholesterol but no triglycerides or chylomicrons in pleural fluid.

    Conclusions:

    • Effective management requires reducing chyle production through low-fat diets or parenteral nutrition.
    • Surgical interventions like chemical pleurodesis or thoracic duct ligation via thoracoscopy are frequently necessary.
    • Both conditions can result in thick, opalescent pleural fluid, varying in color.