Chylothorax: A review of current management strategies

摘要

The most common causes of chylothorax are neoplasm-particularly lymphoma-and trauma. The usual presenting symptom is dyspnea resulting from the accumulation of pleural fluid. The diagnosis of chylothorax is established by measuring triglyceride levels in the pleural fluid; a triglyceride level of greater than 110 mg/dL supports the diagnosis. The initial approach to management involves chest tube drainage of the pleural space. The administration of medium-chain triglyc-erides as a source of fat is often useful. If drainage remains unchanged, parenteral alimentation should be started. Surgical intervention is indicated if conservative management is not successful or if nutritional deterioration is imminent. If chylothorax persists after ligation of the thoracic duct, options may include percutaneous embolization, pleuroperitoneal shunt, and pleurodesis.