CCRN Chylothorax

CCRN Chylothorax Overview

A chylothorax is a type of pleural effusion (a collection of fluid between the membranes lining the lungs called the pleura), but instead of normal pleural fluid, it’s a collection of chyle (lymph fluid). It is caused by a blockage or disruption of the thoracic duct in the chest. Causes include trauma, chest surgeries, and cancers involving the chest (such as lymphomas).

It may be suspected in studies such as a chest X-ray, but the diagnosis is usually made by inserting a needle into the pleural cavity (thoracentesis) and removing fluid. A number of different treatment options are available. Sometimes they go away on their own or with medication, but often they require procedures such as shunt placement, thoracic duct ligation, embolization, and others.

Chylothorax is uncommon in both adults and children, but is the most common form of pleural effusion in newborns.

Signs and Symptoms

Early on, a chylothorax may have few symptoms. As fluid accumulates, shortness of breath is usually the most common symptom. As the effusion grows, people may also develop a cough and chest pain. A fever is usually absent.

When a chylothorax occurs due to trauma or surgery, symptoms usually begin a week to 10 days after the accident or procedure.

Causes

• Tumors
• Surgery
• Trauma

Treatment

With a small chylothorax, the effusion can sometimes be treated conservatively (or with medications), but if symptomatic, it often requires a surgical procedure. The choice of treatment often depends on the underlying cause. The goal of treatment is to remove the fluid from the pleural cavity, keep it from reaccumulating, treat any problems due to the chylothorax (such as nutritional or immune problems), and treat the underlying cause. Some thoracic duct leaks resolve on their own.

For some people, surgery should be considered much sooner, such as those who develop a chylothorax after surgery for esophageal cancer, if the leak is large, or if severe immune, electrolyte, or nutrition problems develop.

Unlike some pleural effusions in which a chest tube is placed to continually drain the effusion, this treatment is not used with a chylothorax as it can result in malnutrition and problems with immune function.