Evaluatıon of Chylothorax: Etiology, Clınıcal Symptoms, Diagnosıs and Treatment Methods

Abstract

Chylothorax refers to the presence of lymphatic fluid in the pleural space secondary to leakage from the thoracic duct or one of its branches. Whatever the etiology is, the main cause is the deterioration of the integrity of the thoracic duct or the obstruction of the duct. In cases of chylothorax, the mostly observed complaint is the dyspnea that occurs with the accumulation of lymphatic fluid in the intrapleural space. If patients left untreated, firstly nutritional insufficiency, fluid and electrolyte imbalance and in progressed phases immune deficiency will be developed due to loss of lymphatic fluid. In the diagnosis of chylothorax, the analysis of pleural fluid that optioned by thoracentesis is important. Milk like appearance, more than 110mg/dL of triglyceride levels in chemical analysis and a ratio of cholesterol/triglyceride smaller than 1 are important criteria for diagnosis. Chylothorax that could be caused by various etiologies may cause mortality which makes its' treatment an obligation as soon as diagnosis established. In treatment, draining of chylotic fluid should be performed primarily to relieve breathing. After then, medium chain triglyceride, total parenteral nutrition and somatostatin or octreotid are used for conservative approach. In cases where those conservative approaches failed, procedures like, surgical ligation of duct, pleuroperitoneal shunting and pleurodesis are being considered for treatment. It needs to be seriously addressed and it should be noted that in delayed treatment chylothorax has a high mortality rate.

Keywords

• chylothorax
• pleural effusion
• treatment