Chylothorax is a rare condition where lymphatic fluid accumulates in the pleural space, caused by a leak or blockage in the thoracic duct. It occurs when the thoracic duct or its tributaries are disrupted or blocked, leading to chyle (intestinal lymphatic fluid) leaking into the pleural cavity. Diagnosis involves finding chylomicrons in pleural fluid (the gold standard) or triglyceride levels above 110 mg/dL. Management focuses on supporting respiratory function, re-expanding the lungs, preventing dehydration and malnutrition, reducing chyle production, and treating the underlying cause. Surgical intervention may be needed if the leak does not close spontaneously within

1. Chylothorax
Aldwin Tanuwijaya
2006513324

2. • Rare condition in which lymphatic fluid accumulate in pleural space
caused by leak or obstruction at thoracic duct.
• It is usually caused by disruption or obstruction of the thoracic duct or
it’s tributaries that lead to leakage of chyle (lymphatic fluid of intestinal
origin) into the pleural cavity
Chylothorax

3. Anatomy

4. Etiology
Non-Traumatic
• Malignancy
• Idiopatic
• Generalized lymphatic
anomaly
• Tuberculosis
• Castleman’s disease
Traumatic
• Esophagectomy
• Lymph node dissection

5. Diagnosis
Chylomicron in pleural fluid (Gold standard)
Triglyceride:
• TG>110 mg/dl  Strongly diagnosed of chylothorax
• TG<110 mg/dl  15 %
• TG<50 mg/dl less likely diagnosed of chylothorax

6. Diagnosis

7. Management
Five major principles of therapy:
Support for
respiratory
function
Re-expansion of
the lung and
obliteration of the
pleural space
Prevention of
dehydration and
malnutrition
Reduction of chyle
production
Treatment of the
underlying cause

8. Support for respiratory function
• Re-expansion of the lungs by drainage of the pleural space
• Aggressive chest physiotherapy
• Mechanical ventilation

9. Re-expansion of the lung and obliteration of
the pleural space
• Thoracentesis
• Thoracostomy
• Pleuroperitoneal shunt
• Pleurodesis

10. Prevention of dehydration and malnutrition
• The content of chyle fluid is prety much nutrient from digestion
system  leaked to external drainage system such as tube
thoracostomy  the risk for developing mal-nutrition and
dehydration
• Volume replacement
• MCT diet
• Total Parenteral Nutrition

11. Reduction of chyle production
• Avoid oral ingestion
• Mechanical ventilation
• Etilferin
• Percutaneous embolization

12. Treatment of the underlying cause
• Chemoteraphy
• Anti tuberculosis drugs

13. Surgical Management
• Timing
• Fourteen days at most between 25% and 50% of leaks close
spontaneously during this interval

14. Surgical Management

15. Surgical Management
• Reduce chylous leak
• Improve lung expansion, obliterate the pleural space

16. References
1. Heffner JE, Broaddus VC, Finlay G. Management of Chylothorax. UpToDate.
https://www.uptodate.com/contents/management-of-chylothorax
2. Fortin D, Inculet RI, Malthaner RA. The Thoracic duct and chylothorax. In: Pearson’s thoracic and
esophageal surgery. Patterson GA, Cooper JD, Deslauriers J. Et al. Philadelphia: Elsevier; 2008
3. Heffner JE, Broaddus VC, Finlay G. Etiology, clinical presentation, and diagnosis of chylothorax. UpToDate.
https://www.uptodate.com/contents/etiology-clinical-presentation-and-diagnosis (accesed at: 7 februari
2018 9:38)