Chylopericardium is a rare cause of chyle loss.
Lymphoma is the most common cause of chylothorax in the non-traumatic aetiology, a computed tomography of the chest and abdomen should be performed to evaluate the mediastinum and abdominal lymphadenopathy.
- primary treatment in case of chylothorax should be directed toward correction of malnutrition and compromised immunological status which is due to the repeated pleural fluid aspiration of chyle with its high levels of protein, fat, electrolytes and lymphocytes
- early recognition of chylous leakage, prompt treatment with fat free and a medium chain triglycerides (MCT) - rich diet and good compliance are effective in the initial management of chylothorax and chylopericardium leading to favorable outcome without complications (1)
- if a defect in thoracic duct due to traumatic injury then this will often close spontaneously (1,3)
- in case of severe dyspnoea, placement of pleuro-peritoneal shunt or chest tube drainage is mandatory (1,3)
- if chylothorax persists for more than four weeks, consideration should be given to surgical exploration with ligation of the thoracic duct (2)
- other modalities including pleurodesis and pleurectomy may also be used
- other nontraumatic chylous effusions may be amenable to medical therapy
Reference:
- Browse NL, Allen DR, Wilson NM. Management of chylothorax. Br J Surg. 1997;84:1711-6.
- Densupsoontorn N, Jirapinyo P, Wongarn R, Thamonsiri N, Nana A, Laohaprasitiporn D, et al. Management of chylothorax and chylopericardium in pediatric patients: Experiences at Siriraj hospital, Bangkok. Asia Pac J Clin Nutr. 2005;14:182-7.
- Talwar A, Lee HJ. A contemporary review of chylothorax. Indian J Chest Dis Allied Sci. 2008;50:343-51