The changing management of chylothorax in the modern era.
Initial conservative therapy is applied to all cases of chylothorax (CTx) with expected excellent outcomes. The indication for aggressive surgical treatment of early CTx remains uncertain and requires rigorous scientific scrutiny. Lymphangiography and lymphoscintigraphy are useful to localize the leak and assess thoracic duct patency as well as to differentiate partial from complete thoracic duct transection. The aetiology of the CTx, flow rate and patient condition dictate the preferred management. Octreotide/somatostatin and etilefrine therapy is highly efficacious in the conservative management of CTx. For patients in whom conservative management fails, those who are good surgical candidates, and those in whom the site of the leak is well identified, surgical repair and/or ligation using minimally invasive techniques is highly successful with limited adverse outcomes. Similarly, if the site of the chylous effusion cannot be well visualized, a thoracic duct ligation via video-assisted thoracic surgery is the gold standard approach. A pleuroperitoneal or less often a pleurovenous shunt is a final option and may be curative in some patients.
['Bender|Bradley|B|', 'Murthy|Vijayashree|V|', 'Chamberlain|Ronald S|RS|']
D002916:Chylothorax D019468:Disease Management D004322:Drainage D005260:Female D005544:Forecasting D006801:Humans D008026:Ligation D008220:Lymphography D008297:Male D015282:Octreotide D018700:Pleurodesis D013902:Radiography, Thoracic D012720:Severity of Illness Index D013004:Somatostatin D020775:Thoracic Surgery, Video-Assisted D014057:Tomography, X-Ray Computed
Chylothorax Chylothorax management Chylous leak Iatrogenic chylothorax Postoperative chylothorax Traumatic chylothorax