From the Guidelines
The treatment for chylothorax should initially involve conservative measures, including thoracentesis, dietary modifications, and adjunctive therapy with somatostatin or octreotide, with surgical intervention such as thoracic duct embolization (TDE) considered if conservative management fails after 2 weeks or if daily outputs are high [1@]. The goal of treatment is to reduce chyle production, manage symptoms, and address the underlying cause of the chylothorax. Conservative treatment approaches have a success rate of around 50% in nonmalignant etiologies, but are less effective in neoplastic etiologies [1@].
Key Considerations
- Conservative measures include management of the underlying disease, thoracentesis, and dietary modifications such as total parenteral nutrition or a nonfat diet to reduce production of chyle [1@].
- Adjunctive therapy may include somatostatin, etilefrine, or nitric oxide, with the underlying etiology determining the efficacy [1@].
- Invasive treatments, such as TDE, are considered if conservative treatment has not resolved the chylothorax after 2 weeks, or in cases of higher-output chylothoraces or underlying neoplastic etiologies [1@].
- TDE has been shown to have a high clinical success rate, particularly in traumatic cases, with a success rate of over 90% reported in some studies [1@].
Treatment Approach
- Initial management: thoracentesis to drain the chylous fluid, followed by chest tube placement for continuous drainage if needed.
- Conservative treatment: dietary modifications, adjunctive therapy with somatostatin or octreotide.
- Surgical intervention: considered if conservative management fails after 2 weeks or if daily outputs are high, with options including thoracic duct ligation, pleurodesis, and TDE.
- Monitoring: patients should be monitored for nutritional deficiencies and immunological complications due to the loss of proteins, lymphocytes, and fat-soluble vitamins in the chylous fluid.
From the Research
Treatment Options for Chylothorax
The treatment for chylothorax, which is the accumulation of chyle in the thoracic cavity, can vary depending on the severity and cause of the condition. The following are some of the treatment options:
- Conservative treatment, which includes dietary measures and medications such as octreotide to decrease chylothorax flow 1, 2, 3
- Parenteral nutrition to cover the patient's nutritional demands and compensate for protein and energy losses due to chylothorax 1, 2
- Low-fat diet supplemented with intermediate-chain triglycerides (ICT), fat-free enteral nutrition, or enteral nutrition with a high percentage of ICT 1
- Surgical treatment, such as ligation of the thoracic duct, pleurodesis, or a pleuroperitoneal shunt, which is usually considered when conservative treatment fails 4, 5
- Interventional radiological treatments, such as percutaneous thoracic duct embolization or the percutaneous destruction of lymphatic vessels, which have been shown to be effective in some cases 4
Medications Used in Treatment
Some medications have been used to treat chylothorax, including:
- Octreotide, a long-acting somatostatin analogue, which has been shown to be safe and effective in reducing chylothorax flow 1, 2, 3
- The use of lipid emulsions is not contraindicated, as they do not reach the lymphatic system 1
Success Rates of Treatment Options
The success rates of different treatment options for chylothorax vary:
- Conservative treatment has been shown to be successful in 20% to 80% of cases 4
- Surgical treatment has been shown to be successful in 25% to 95% of cases, but is associated with higher complication and mortality rates 4, 5
- Interventional radiological treatments have been shown to be successful in about 70% of cases, with a lower complication rate compared to surgical treatment 4