Chylothorax

Introduction

Chylothorax refers to a disease where, due to various causes, the thoracic duct or its branches are damaged, leading to the accumulation of chyle in the pleural cavity.

Causes

The causes of chylothorax are categorized into two types: traumatic and non-traumatic.

Traumatic chylothorax is often caused by surgical operations, medical invasive procedures, puncture wounds, or blunt trauma, with surgery being the most common cause.

Non-traumatic chylothorax often happens when the lymphatic vessels are damaged by tumors or inflammation, such as lymphoma, lymphangioma, lung cancer, esophageal cancer, tuberculosis, filariasis, systemic lupus erythematosus, and sarcoidosis. Additionally, the cause of some idiopathic chylothorax cases remains unclear, which may be linked to genetic mutations or congenital abnormalities of the lymphatic system.

Symptoms

Besides symptoms caused by the primary disease, chylothorax typically manifests as coughing, expectoration, chest tightness, shortness of breath, and palpitations. When accompanied by an infection, it may introduce additional symptoms like chest pain, fever, and chills. Significant fluid accumulation in chylothorax can lead to respiratory distress or even respiratory failure. Furthermore, hemorrhagic chylothorax can induce symptoms of anemia or hypovolemic shock, including dizziness, fatigue, and thirst, and may also result in malnutrition, weight loss, weakened immunity, and edema.

Treatment

Treatment strategies for chylothorax are generally tailored based on the underlying cause and the severity of the condition. Here are some common treatment methods:

1. Conservative treatment: Adopting a low-fat or fat-free diet and supplementing with albumin to reduce lymphatic fluid production.

2. Closed chest drainage: Draining accumulated chyle to alleviate symptoms.

3. Chemical pleurodesis: Individualizing medication based on the type of chylothorax and test results, this method involves injecting chemicals to induce pleural adhesion, thereby reducing the production and accumulation of chyle.

Additionally, if chylothorax is caused by other conditions such as malignancies or tuberculosis, then treatment targets these underlying causes, such as anti-cancer therapy or anti-tuberculosis treatment, are also required.

Diagnostic Methods

The diagnosis of chylothorax is primarily based on analyzing pleural effusion through methods like thoracentesis, chest X-rays, B-scan ultrasound, and lymphangiography. The critical aspect of these examinations is to determine the underlying cause, particularly ruling out secondary chylothorax resulting from common conditions such as tumors or tuberculosis.