Abstract:

Chylothorax is defined as the accumulation of lymphatic fluid in the pleural cavity. It results from congenital and acquired causes. Although the etiology of congenital chylothorax is not fully understood, it has been suggested to be a developmental disorder of the lymphatic system. Congenital chylothorax is often accompanied by hydrops fetalis. The diagnosis is made by measurement of the triglyceride level in fluid above 110 mg/dl and total cell count above 1000/ml with 80% lymphocyte. The severity of the clinical condition in chylothorax is determined by the amount of accumulated chylous fluid. Whilst some newborns are asymptomatic or have mild respiratory distress as a clinical symptom, the majority of the cases, if not treated, present with potentially life-threatening respiratory distress. Conservative and surgical methods are used in the treatment of chylothorax. Conservative therapy includes the treatment of the underlying disease, continuous drainage through repeated thoracentesis or thoracic tube, total parenteral nutrition following the suspension of enteral nutrition, and a diet containing medium chain triglycerides. Octreotide use is offered if there is no response to these methods. The two parameters used to define failure of conservative therapy are the duration and the volume of the continuing lymphatic drainage. In cases where octreotide therapy fails, chemical pleurodesis and surgical treatment should be tried. Surgical treatment includes thoracoscopic pleurodesis, surgical abrasion, pleuroperitoneal shunt placement, and thoracic ductus ligation. The prognosis of chylothorax varies depending on the underlying etiology. The prognosis of chylothorax is generally good with appropriate treatment. Nonetheless, the severity of accompanying pulmonary hypoplasia, and presence of prematurity and hydrops have been reported to be among the factors increasing mortality rate

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