Etiology and management of pediatric chylothorax

https://doi.org/10.1067/mpd.2000.104287Get rights and content

Objectives: To determine the incidence and etiology of chylothorax and to assess our therapeutic management approach.

Study design: We reviewed 51 patients diagnosed with chylothorax over a 12-year period. Cause, interval between operation and diagnosis, duration of chylothorax, and total volume loss per weight were recorded.

Results: Chylothorax was diagnosed in 46 children after cardiothoracic surgery, giving an incidence of 2.59% (46/1842); in 1 child chylothorax occurred after chest trauma, and in 4 the chylothorax was congenital or a manifestation of lymph angiomatosis. Three etiologic groups were identified: group 1, direct injury to the thoracic duct (33/51 = 65%); group 2, thrombosis and/or high venous pressure in the superior vena cava (14/51 = 27%); and group 3, congenital (4/51 = 8%). Conservative treatment was the only treatment in 80% of the patients. Surgical procedures consisted of 4 ligations of the thoracic duct, placement of 7 pleurodesis shunts, and placement of 2 pleuroperitoneal shunts. Patients in groups 2 and 3 were at higher risk for failure of conservative treatment (P < .005). Longer duration of chylothorax and higher volume of drainage were present in group 2 compared with group 1 (P <.01).

Conclusion: Conservative treatment was successful in 80% of the patients with our management approach. Prevention, early recognition, and treatment of potential complications, such as superior vena cava thrombosis or obstruction, may further improve success of conservative treatment. Congenital chylothorax seems different and may require a specific approach.

References (38)

  • GK Griffin et al.

    Systemic lymphangiomatosis approach of lymphangiography and computed tomography

    J Comput Assist Tomogr

    (1986)
  • RG Azizkhan et al.

    Pleuroperitoneal shunts in the management of persistent chylothotax

    J Pediatr Surg

    (1983)
  • KS Rheuban et al.

    Pleuroperitoneal shunts for refractory chylothorax after operation for congenital heart disease

    Ann Thorac Surg

    (1992)
  • MC Murphy et al.

    Pleuroperitoneal shunts in the management of persistent chylothorax

    Ann Thorac Surg

    (1989)
  • DD Graham et al.

    Use of video-assisted thoracic surgery in the treatment of chylothorax

    Ann Thorac Surg

    (1994)
  • PC Rimensberger et al.

    Treatment of a persistent postoperative chylothorax with somatostatin

    Ann Thorac Surg

    (1998)
  • C Le Coultre et al.

    Postoperative chylothorax in children: differences between vascular and traumatic origin

    J Pediatr Surg

    (1991)
  • R Campbell et al.

    Chylothorax after surgery for congenital heart disease [abstract]

    Am J Respir Crit Care Med

    (1997)
  • L Paes et al.

    Chylothorax-features and management strategies

    Care Critically III

    (1996)
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