Pleural Effusion-Chylothorax


Epidemiology

Definition

  • Chylothorax is the Presence of Chylus (Lymph) in the Pleural Space Due to Damage to the Thoracic Duct

Incidence

Series of Patients with Chylothorax (Chest, 1992) [MEDLINE]

  • Nontraumatic Cases (72%)
    • Malignancy (46%)
      • Lymphoma: 37%
      • Non-Lymphoma (Lung Cancer, Mediastinal Malignancy, Metastatic Extrathoracic Malignancy, Sarcoma, Leukemia): 9%
    • Non-Malignant (27%)
      • Idiopathic: 14%
      • Other (Benign Tumors, Lymphangioleiomyomatosis, Intestinal Lymphangiectasis, Protein-Losing Enteropathy, Regional Ileitis, Pleuritis, Cirrhosis, Thoracic Aortic Aneurysm, Lupus, Tuberculosis, Sarcoidosis, Amyloidosis, Venous Thrombosis, Mitral Stenosis, Nephrosis, Thyroid Goiter, Tuberous Sclerosis, Lymphatic Filariasis, Congestive Heart Failure, Down Syndrome, Noonan Syndrome, etc): 13%
  • Traumatic Cases (28%)
    • Surgical (25%)
      • Cardiovascular Surgery, Aortic Surgery, Neck Surgery, Spine Surgery, Thoracoplasty, Esophagectomy, Lobectomy, Pneumonectomy, Mediastinal Mass Resection, Bochdalek Herniorrhaphy, Transabdominal Vagotomy, Central Venous Catheter, Esophageal Endoscopic Sclerotherapy, Embolization for Pulmonary Arteriovenous Malformation, Pacemaker Insertion
    • Nonsurgical (3%)
      • Penetrating/Nonpenetrating Trauma to the Neck, Thorax, or Upper Abdomen, Straining, Coughing, Yawning, Vomiting

Mayo Clinic Series of Patients with Chylothorax (Mayo Clin Proc, 2005) [MEDLINE]

  • General Comments
    • Lower Incidence of Lymphoma-Associated Cases May Be Related to the Earlier Diagnosis of Lymphoma Prior to Development of Chylothorax
    • Higher Incidence of Surgery-Associated Cases May Be Related to Mayo Clinic Being a Tertiary Referral Center with Higher Numbers of Cardiovascular Procedures
  • Nontraumatic Cases (50%)
    • Malignancy (17%)
      • Lymphoma: 11%
      • Non-Lymphoma (Lung Cancer, Mediastinal Malignancy, Metastatic Extrathoracic Malignancy, Sarcoma, Leukemia): 5%
    • Non-Malignant (XX%)
      • Idiopathic: 6%
      • Other (Benign Tumors, Lymphangioleiomyomatosis, Intestinal Lymphangiectasis, Protein-Losing Enteropathy, Regional Ileitis, Pleuritis, Cirrhosis, Thoracic Aortic Aneurysm, Lupus, Tuberculosis, Sarcoidosis, Amyloidosis, Venous Thrombosis, Mitral Stenosis, Nephrosis, Thyroid Goiter, Tuberous Sclerosis, Lymphatic Filariasis, Congestive Heart Failure, Down Syndrome, Noonan Syndrome, etc): 27%
  • Traumatic Cases (50%)
    • Surgical (48%)
      • Cardiovascular Surgery, Aortic Surgery, Neck Surgery, Spine Surgery, Thoracoplasty, Esophagectomy, Lobectomy, Pneumonectomy, Mediastinal Mass Resection, Bochdalek Herniorrhaphy, Transabdominal Vagotomy, Central Venous Catheter, Esophageal Endoscopic Sclerotherapy, Embolization for Pulmonary Arteriovenous Malformation, Pacemaker Insertion
    • Nonsurgical (2%)
      • Penetrating/Nonpenetrating Trauma to the Neck, Thorax, or Upper Abdomen, Straining, Coughing, Yawning, Vomiting

Etiology

Neoplasm

General Comments

Lymphoma (see Lymphoma)

Lung Cancer (see Lung Cancer)

Chronic Lymphocytic Leukemia (CLL) (see xxxx)

Kaposi Sarcoma (see Kaposi Sarcoma)

Mediastinal Malignancy (with/without Superior Vena Cava (SVC) Syndrome)

Multiple Myeloma (see Multiple Myeloma)

Benign Tumors of Mediastinum

Traumatic Chylothorax

General Comments

Surgery/Procedures

Trauma

Neonatal Chylothorax

Other

Amyloidosis (see Amyloidosis)

Aortic Aneurysm (see XX)

Behcet’s Disease (see Behcet’s Disease)

Castleman’s Disease (Angiocentric or Giant Lymph Node Hyperplasia (see Castleman’s Disease)

Cirrhosis (see Cirrhosis)

Congenital Chylothorax

Congenital or idiopathic disorders of the lymphatic system

Congestive Heart Failure (CHF) (see Congestive Heart Failure)

Constrictive Pericarditis (see xxxx)

Dasatinib (Sprycel) (see Dasatinib)

Down Syndrome

Fibrosing Mediastinitis (see Granulomatous Mediastinitis and Fibrosing Mediastinitis)

Idiopathic Chylothorax

Lymphatic Filariasis (see Lymphatic Filariasis)

Goiter (see Goiter)

Gorham-Stout Disease (Gorham’s Disease) (see Gorham-Stout Disease)

Histoplasmosis (see Histoplasmosis)

Immunoglobulin G4 (IgG4)-Related Pleural Disease (see XXX

Intestinal Lymphangiectasia (Noonan’s Syndrome)

Lymphangioleiomyomatosis (LAM) (see Lymphangioleiomyomatosis)

Mediastinal Lymphadenopathy (see Mediastinal Mass)

Nephrotic Syndrome (see Nephrotic Syndrome)

Noonan Syndrome

POEMS Syndrome

Radiation Therapy (XRT) (see Radiation Therapy)

Regional Ileitis

Retrosternal Goiter

Sarcoidosis (see Sarcoidosis)

Subclavian Vein Thrombosis

Superior Vena Cava (SVC) Syndrome (see Superior Vena Cava Syndrome)

Systemic Lupus Erythematosus (SLE) (see xxxx)

Thoracic Aortic Aneurysm (see Thoracic Aortic Aneurysm)

Thoracic Duct Cyst

Thoracic Duct Lymphangitis

Transdiaphragmatic Movement of Chylous Ascites (see

Tuberculosis (see Tuberculosis)

Tuberous Sclerosis (see Tuberous Sclerosis)

Turner Syndrome

Waldenström Macroglobulinemia

Yellow Nail Syndrome (see Yellow Nail Syndrome)


Physiology


Diagnosis


Clinical Manifestations

Chyloma

Pleural Effusion


Treatment

Dietary Modification with Observation

Chemical Pleurodesis

Pleuroperitoneal Shunt (see Pleuroperitoneal Shunt)

Thoracoscopic Ligation of the Thoracic Duct

Mediastinal Radiation Therapy (XRT) (see Radiation Therapy)


References