ABSTRACT

Introduction: Chylothorax is the presence of lymphatic fluid in the pleural space. Mexico’s National Institute of Respiratory Diseases (Instituto Nacional de Enfermedades Respiratorias) is a national level reference center; however, the frequency, causes and clinical evolution of patients with chylothorax are currently unknown.
Material and methods: Retrospective chart review of patients with chylothorax admitted to the hospital between January 1999 and December 2009.
Results: A total of 15 files were identified (47% women). Mean age was 33 years (iqr 20-67), and the average length of hospital stay was 27 days (iqr 26-38). The frequency of occurrence was 0.03% out of the 49,068 patients admitted during that period. Of the samples analyzed, 53.3% had a milky aspect, while 26% were transudates. The most frequent cause of chylothorax was non-traumatic (60%) and, of those cases, neoplasias were the most common (67%). Treatment included ligature of the thoracic conduct, total parenteral nutrition and pleurodesis. The rate of in-hospital mortality was 13.3% and was associated with sepsis.
Conclusions: The frequency of chylothorax at our center is low, as we identified only one patient with chylothorax for every 3.3 thousand hospital admissions. The non-routine measuring of triglycerides, added to the limited availability of testing for chylomicrons, suggest that chylothorax is underdiagnosed. In our series, both the causes of chylothorax and the treatment modalities are similar to those described in other studies; however, in-hospital mortality is high and related to sepsis.

KEYWORDS

Chylothorax, pleural effusion, transudate, lymphoma, pleurodesis.

REFERENCES

1. Hillerdal G. Chylothorax and pseudochylothorax. Eur Respir J 1997;10:1157-1162.

2. Agrawal V, Doelken P, Sahn SA. Pleural fluid analysis in chylous pleural effusion. Chest 2008;133:1436-1441.

3. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 2010;104:1-8.

4. Romero S. Nontraumatic chylothorax. Curr Opin Pulm Med 2000;6:287-291.

5. Doerr CH, Allen MS, Nichols FC, 3rd, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005;80:867-870.

6. Maldonado F, Hawkins FJ, Daniels CE, Doerr CH, Decker PA, Ryu JH. Pleural fluid characteristics of chylothorax. Mayo Clin Proc 2009;84:129-133.

7. Light RW. Clinical practice. Pleural effusion. N Engl J Med 2002;346:1971-1977.

8. Diaz-Guzman E, Culver DA, Stoller JK. Transudative chylothorax: report of two cases and review of the literature. Lung 2005;183:169-175.

9. Skouras V, Kalomenidis I. Chylothorax: diagnostic approach. Curr Opin Pulm Med 2010;16:387-393.

10. Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 2007;32:362-369.

11. Mares DC, Mathur PN. Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series. Chest 1998;114:731-735.

12. Rizzardi G, Loy M, Marulli G, Rea F. Persistent chylothorax in lymphangioleiomyomatosis treated by intrapleural instillation of povidone. Eur J Cardiothorac Surg 2008;34:214-215.

13. Han C, Guo L, Wang KJ, Zhao JQ. Bilateral chylothorax following neck dissection for thyroid cancer. Int J Oral Maxillofac Surg 2009;38:1119-1122.

14. Fairfax AJ, McNabb WR, Spiro SG. Chylothorax: a review of 18 cases. Thorax 1986;41:880-885.