Chylothorax
Chylothorax | |
ICD-10 | I89.8, J91 |
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ICD-9 | 457.8, 511.9 |
DiseasesDB | 29612 |
eMedicine | med/381 |
MeSH | D002916 |
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Overview
Chylothorax, a type of pleural effusion is the accumulation of chyle in the pleural cavity secondary to destruction or obstruction of the thoracic duct or its tributaries. Chylothorax is most commonly right-sided(50%) because of the anatomic location of the thoracic duct, left-sided (33.3%), or bilateral (16.66%). Thoracic duct damage above the fifth thoracic vertebra results in a left-sided chylothorax whereas damage to the thoracic duct below fifth thoracic vertebra leads to a right-sided effusion.
Historical Perspective
Classification
Chylothorax may be classified as[1][2]
Chylothorax | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Non-traumatic | Traumatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Malignancy | Diseases | Idopathic | Non- Iatrogenic | Iatrogenic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
- Sarcoidosis
- Haemangiomatosis - Tuberculosis - Heart failure -Benign tumour - Amyloidosis -Lymphangiolei -omyomatosis - Filariasis - Transdiaphrgmatic movement of chylous ascitic fluid - SVC obstruction | - Knife injury
- Childbirth - Forceful cough or emesis - Blunt trauma to the thorax - Bullet wound | - Radiation
- Thoracic surgery - Head and neck surgery | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiology
Causes
Its cause is usually leakage from the thoracic duct or one of the main lymphatic vessels that drain to it. The most common causes are lymphoma and trauma caused by thoracic surgery. The effusion is characteristically white and milky in appearance and contains high levels of triglycerides.
In animals, chylothorax usually results from diseases that cause obstruction to the thoracic duct preventing lymph from draining normally into the venous system. Examples include tumors, heartworm disease, right sided cardiac failure, or idiopathic lymphangiectasia. The most effective form of treatment is surgical ligation of the thoracic duct combined with partial pericardectomy.[3]
Differentiating chylothorax from other Diseasess
- Cirrhosis
- Congenital chylothorax
- Filariasis
- Iatrogenic
- Idiopathic
- Lymphoma
- Nonlymphomatous malignancies
- Nonsurgical penetrating trauma
- Tuberculosis [4] [5]
Epidemiology and Demographics
- The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Patients of all age groups may develop [disease name].
- [Disease name] is more commonly observed among patients aged [age range] years old.
- [Disease name] is more commonly observed among [elderly patients/young patients/children].
Gender
- [Disease name] affects men and women equally.
- [Gender 1] are more commonly affected with [disease name] than [gender 2].
- The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
Race
- There is no racial predilection for [disease name].
- [Disease name] usually affects individuals of the [race 1] race.
- [Race 2] individuals are less likely to develop [disease name].
Risk Factors
Please refere to classification for the common risk factors in the development of Chylothorax] are[1][2]
- Hepatectomy
- Esophagectomy
- Lung surgery
- Cardiac surgery
- Retroperitoneal surgery around the cisterna chyli, example abdominal aortic aneurysm surgery
Screening
Natural History, Complications and Prognosis
- If left untreated, 100% of patients with chylothorax may progress to develop hypovolaemia, malnutrition; as a result of protein, fats and vitamins loss, hyponatremia and hypocalcemia due to electrolyte loss.[2]
- Common complications of chylothorax include malnutrition, immunosuppression and respiratory distress.[2]
- Prognosis is generally good and the mortality rate from chylothorax has considerably improved from approximately 50% as described in 1948. This is due to the more aggressive management plans implemented. Currently, the worst prognosis is seen in malignant and bilateral chylothoraces.[2]
Diagnosis
Diagnostic Study of Choice
- The diagnosis of chylothorax is based on an elevated concentration of pleural fluid triglyceride >110 mg/dL.[1]
History and Symptoms
- Symptoms of chylothorax depresend on the rate of chyle accumulation and etiology. Symptoms may include the following[1][2]
- Dyspnea
- Respiratory failure
- Cough
- Swelling in the supraclavicular fossa
- Severe chest pain
- Tachycardia
- Weight loss
- Muscle wasting
- Immunodeficiency
- Malnutrition
Physical Examination
- Patients with [disease name] usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- An elevated concentration of pleural fluid triglyceride >110 mg/dL is diagnostic of chylothorax.[1]
Electrocardiogram
X-ray
Ultrasound
CT scan
Thoracic CT scan may be helpful in the diagnosis of chylothorax. Findings on CT scan suggestive of/diagnostic of chylothorax include[1]
MRI
Other Imaging Findings
Other diagnostic studies for chylothorax include
- Lymphangiography with Lipiodol (ethiodized oil) [1] which demonstrates extravasation into the pleural space.
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
Chylothorax is a medical emergency and requires prompt treatment. Medical therapy for chylothorax include[1]
Surgery
Surgery is the mainstay of therapy for chylothorax[1]
Primary Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
Secondary Prevention
See also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S (2018). "Chylothorax after hepatectomy: a case report". J Med Case Rep. 12 (1): 347. doi:10.1186/s13256-018-1882-x. PMC 6260677. PMID 30474568.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 McGrath EE, Blades Z, Anderson PB (2010). "Chylothorax: aetiology, diagnosis and therapeutic options". Respir Med. 104 (1): 1–8. doi:10.1016/j.rmed.2009.08.010. PMID 19766473.
- ↑ Birchard SJ, Smeak DD, McLoughlin MA (1998). "Treatment of idiopathic chylothorax in dogs and cats". J. Am. Vet. Med. Assoc. 212 (5): 652–7. PMID 9524635. Unknown parameter
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ignored (help) - ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X