CHYLOTHORAX

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Chylothorax

A chylothorax occurs when the thoracic duct is disrupted and chyle accumulates in the pleural space. The most common cause of chylothorax is trauma, but it also may result from tumors in the mediastinum. Patients with chylothorax present with dyspnea, and a large pleural effusion is present on the chest radiograph. Thoracentesis reveals milky fluid, and biochemical analysis reveals a triglyceride level that exceeds 110 mg/dL. Patients with chylothorax and no obvious trauma should have a lymphangiogram and a mediastinal computed tomographic (CT) scan to assess the mediastinum for lymph nodes. The treatment of choice for most chylothoraces is implantation of a pleuroperitoneal shunt. Patients with chylothoraces should not undergo prolonged tube thoracostomy with chest tube drainage because this will lead to malnutrition and immunologic incompetence.