Treatment of Chylothorax

Abstract

The accumulation of lymphatic fluid absorbed in the lymphatic system in the intrapleural space is called chylothorax. Traumatic and nontraumatic causes are included in the etiology. Pleural fluid analysis obtained by thoracentesis has an important place in the diagnosis of chylothorax. A triglyceride> 110 mg / dL and cholesterol / triglyceride ratio <1 in pleural fluid is defined as chylothorax. Fluid drainage with a thoracic tube is usually the first treatment method. A high protein, low fat diet with medium chain fatty acids is recommended. If necessary, oral nutrition is stopped and supported with parenteral nutrition. If chylous drainage continues, somatostatin or octreotide therapy is given in the early period. If there is no response to conservative and medical treatment and if the drainage is not high, the alternative treatment methods is evaluated. Pleurodesis, pleuroperitoneal shunt, and embolization are alternative options. Surgical treatment begins with ductus ligation with video-assisted thoracoscopic surgery or thoracotomy. Transabdominal thoracic duct mass ligation is a treatment method in appropriate indication. Laparoscopic cisterna chile ligation is another surgical treatment method in cases where treatment is not successful. In this article, the treatment of chylothorax has been evaluated in the light of the literature.