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Management of chylothorax

N L Browse1, D R Allen, N M Wilson

  • 1Department of Surgery, St. Thomas' Hospital, London, UK.

The British Journal of Surgery
|February 4, 1998
PubMed
Summary
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Chylothorax management is uncertain. Parietal pleurectomy effectively prevents effusion reaccumulation, offering a successful treatment for this rare condition when the lymphatic abnormality is not clearly identifiable.

Area of Science:

  • Thoracic Surgery
  • Gastroenterology
  • Pediatric Surgery

Background:

  • Chylothorax, a rare condition, can be primary or secondary.
  • Optimal management strategies for chylothorax remain uncertain.
  • This study reviews cases of chylothorax managed between 1956 and 1986.

Purpose of the Study:

  • To evaluate the effectiveness of different management strategies for chylothorax.
  • To identify the most successful treatment for preventing chylothorax recurrence.
  • To provide guidance on when to transition from conservative to surgical management.

Main Methods:

  • Retrospective review of twenty chylothorax cases.
  • Cases included primary chylothorax and secondary chylothorax due to malignancy, subclavian vein thrombosis, or lymphangioma.

Related Experiment Videos

  • Treatment outcomes were analyzed, including reaccumulation of effusion and long-term survival.

    • Main Results:

    • Parietal pleurectomy demonstrated the highest success rate in preventing effusion reaccumulation.
    • Thoracic duct-azygous vein anastomoses showed poor long-term patency.
    • Twelve out of twenty patients were alive and free from effusion 3-22 years post-treatment.

    Conclusions:

    • Lymphangiography is recommended to determine the cause and location of lymphatic abnormalities in chylothorax.
    • Conservative management should be discontinued if fluid loss thresholds are exceeded.
    • Parietal pleurectomy is the preferred treatment for unidentified lymphatic leaks; direct ligation is suitable for isolated leaks.