Paediatric Respiratory Reviews
Volume 10, Issue 4 , Pages 199-207 , December 2009

Chylothorax: Diagnosis and Management in Children

  • Manuel Soto-Martinez

      Affiliations

    • Clinical and Research Fellow in Paediatric Respiratory Medicine, Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, 50 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
    • Infection, Immunity and Environment Theme, Murdoch Childrens Research Institute, Melbourne, Australia
    • Corresponding Author InformationCorresponding author. Tel.: +61 03 9345 5818; Fax: +61 03 9349 1289.
    • ,
  • John Massie

      Affiliations

    • Consultant in Respiratory Medicine, Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, 50 Flemington Road, Parkville, Melbourne, Victoria 3052, Australia
    • Infection, Immunity and Environment Theme, Murdoch Childrens Research Institute, Melbourne, Australia
    • Department of Paediatrics, University of Melbourne, Australia
    • Tel.: +61 03) 9345 5818; Fax: +61 03 9349 1289.

References 

  1. Hillerdal G. Chylothorax and pseudochylothorax. Eur. Respir. J. 1997;10:1157–1162
  2. Beghetti M, La Scala G, Belli D, Bugmann P, Kalangos A, Le Coultre C. Etiology and management of pediatric chylothorax. J. Pediatr. 2000;136:653–658
  3. Buttiker V, Fanconi S, Burger R. Chylothorax in children: guidelines for diagnosis and management. Chest. 1999;116:682–687
  4. Romero S. Nontraumatic chylothorax. Curr. Opin. Pulm. Med. 2000;6:287–291
  5. Van Pernis P. Variations of the thoracic duct. Surgery. 1949;26:806–809
  6. Merrigan BA, Winter DC, O'Sullivan GC. Chylothorax. Br. J. Surg. 1997;84:15–20
  7. Ross JK. A review of the surgery of the thoracic duct. Thorax. 1961;16:12–21
  8. Kinnaert P. Anatomical variations of the cervical portion of the thoracic duct in man. J. Anat. 1973;115:45–52
  9. Soto-Martinez ME, Clifford V, Clarnette T, Ranganathan S, Massie RJ. Spontaneous chylothorax in a 2-year-old child. Med. J. Aust. 2009;190:262–264
  10. Garcia Restoy E, Bella Cueto F, Espejo Arenas E, Aloy Duch A. Spontaneous bilateral chylothorax: uniform features of a rare condition. Eur. Respir. J. 1988;1:872–873
  11. Paes ML, Powell H. Chylothorax: an update. Br. J. Hosp. Med. 1994;51:482–490
  12. Bach AC, Babayan VK. Medium-chain triglycerides: an update. Am. J. Clin. Nutr. 1982;36:950–962
  13. Seaton TB, Welle SL, Warenko MK, Campbell RG. Thermic effect of medium-chain and long-chain triglycerides in man. Am. J. Clin. Nutr. 1986;44:630–634
  14. St-Onge M-P, Jones PJH. Physiological effects of medium-chain triglycerides: potential agents in the prevention of obesity. J. Nutr. 2002;132:329–332
  15. Doerr CH, Miller DL, Ryu JH. Chylothorax. Seminars in Respiratory and Critical Care Medicine. 2001;22:617–626
  16. Browse NL, Allen DR, Wilson NM. Management of chylothorax. Br. J. Surg. 1997;84:1711–1716
  17. Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin. Proc. 1980;55:700–704
  18. Agrawal V, Sahn SA. Lipid pleural effusions. Am. J. Med. Sci. 2008;335:16–20
  19. Agrawal V, Doelken P, Sahn SA. Pleural fluid analysis in chylous pleural effusion. Chest. 2008;133:1436–1441
  20. van Straaten HL, Gerards LJ, Krediet TG. Chylothorax in the neonatal period. Eur. J. Pediatr. 1993;152:2–5
  21. Chan DK, Ho NK. Noonan syndrome with spontaneous chylothorax at birth. Aust. Paediatr. J. 1989;25:296–298
  22. Van Aerde J, Campbell AN, Smyth JA, Lloyd D, Bryan MH. Spontaneous chylothorax in newborns. Am. J. Dis. Child. 1984;138:961–964
  23. Rocha G. Pleural effusions in the neonate. Curr. Opin. Pulm. Med. 2007;13:305–311
  24. Dubin PJ, King IN, Gallagher PG. Congenital chylothorax. Curr. Opin. Pediatr. 2000;12:505–509
  25. Sardet A. [Chylothorax in children and newborn infants]. Arch. Fr. Pediatr. 1981;38:455
  26. Zito L, Keszler M. Massive edema and bilateral pleural effusions in a newborn infant. Ann. Allergy. 1989;63:277–280
  27. Dendale J, Comet P, Amram D, Lesbros D. [Prenatal diagnosis of chylothorax]. Arch. Pediatr. 1999;6:867–871
  28. Randolph JG, Gross RE. Congenital chylothorax. Arch. Surg. 1957;74:405
  29. Chernick V, Reed MH. Pneumothorax and chylothorax in the neonatal period. J. Pediatr. 1970;76:624–632
  30. Faul JL, Berry GJ, Colby TV, Ruoss SJ, Walter MB, Rosen GD, et al. Thoracic lymphangiomas, lymphangiectasis, lymphangiomatosis, and lymphatic dysplasia syndrome. Am. J. Respir. Crit. Care Med. 2000;161:1037–1046
  31. Huber A, Schranz D, Blaha I, Schmitt-Mechelke T, Schumacher R. Congenital pulmonary lymphangiectasia. Pediatr. Pulmonol. 1991;10:310–313
  32. Johnstone DW. Postoperative chylothorax. Chest Surg. Clin. N. Am. 2002;12:597–603
  33. Panthongviriyakul C, Bines JE. Post-operative chylothorax in children: an evidence-based management algorithm. J. Paediatr. Child Health. 2008;44:716–721
  34. Chan S-y , Lau W, Wong WHS, Cheng L-c , Chau AKT, Cheung Y-f. Chylothorax in children after congenital heart surgery.[see comment]. Ann. Thorac. Surg. 2006;82:1650–1656
  35. Cannizzaro V, Frey B, Bernet-Buettiker V. The role of somatostatin in the treatment of persistent chylothorax in children. Eur. J. Cardiothorac. Surg. 2006;30:49–53
  36. Worthington MG, de Groot M, Gunning AJ, von Oppell UO. Isolated thoracic duct injury after penetrating chest trauma. Ann. Thorac. Surg. 1995;60:272–274
  37. Dhande V, Kattwinkel J, Alford B. Recurrent bilateral pleural effusions secondary to superior vena cava obstruction as a complication of central venous catheterization. Pediatrics. 1983;72:109–113
  38. Anderst JD. Chylothorax and child abuse. Pediatr Crit Care Med. 2007;8:394–396
  39. Geismar SL, Tilelli JA, Campbell JB, Chiaro JJ. Chylothorax as a manifestation of child abuse. Pediatr. Emerg. Care. 1997;13:386–389
  40. Guleserian KJ, Gilchrist BF, Luks FI, Wesselhoeft CW, DeLuca FG. Child abuse as a cause of traumatic chylothorax. J. Pediatr. Surg. 1996;31:1696–1697
  41. Thurer RJ. Chylothorax: a complication of subclavian vein catheterization and parenteral hyperalimentation. J. Thorac. Cardiovasc. Surg. 1976;71:465–468
  42. Ruggiero RP, Caruso G. Chylothorax--a complication of subclavian vein catheterization. Jpen: Journal of Parenteral & Enteral Nutrition. 1985;9:750–753
  43. Connor FL, Angelides S, Gibson M, Larden DW, Roman MR, Jones O, et al. Successful resection of localized intestinal lymphangiectasia post-Fontan: role of (99m)technetium-dextran scintigraphy. Pediatrics. 2003;112:e242–e247
  44. Van Veldhuizen PJ, Taylor S. Chylothorax: a complication of a left subclavian vein thrombosis. Am. J. Clin. Oncol. 1996;19:99–101
  45. Chan EH, Russell JL, Williams WG, Van Arsdell GS, Coles JG, McCrindle BW. Postoperative chylothorax after cardiothoracic surgery in children.[see comment]. Ann. Thorac. Surg. 2005;80:1864–1870
  46. Doerr CH, Allen MS, Nichols FC, Ryu JH. Etiology of chylothorax in 203 patients. [see comment]. Mayo Clin. Proc. 2005;80:867–870
  47. Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur. J. Cardiothorac. Surg. 2007;32:362–369
  48. Easa D, Balaraman V, Ash K, Thompson B, Boychuk R. Congenital chylothorax and mediastinal neuroblastoma. J. Pediatr. Surg. 1991;26:96–98
  49. Cakir E, Gocmen B, Uyan ZS, Oktem S, Kiyan G, Karakoc F, et al. An unusual case of chylothorax complicating childhood tuberculosis. Pediatr. Pulmonol. 2008;43:611–614
  50. Tutor JD, Schoumacher RA, Chesney PJ. Chylothorax associated with histoplasmosis in a child. Pediatr. Infect. Dis. J. 2000;19:262–263
  51. Grobbelaar M, Andronikou S, Goussard P, Theron S, Mapukata A, George R. Chylothorax as a complication of pulmonary tuberculosis in children. Pediatr. Radiol. 2008;38:224–226
  52. Cogar BD, Groshong TD, Turpin BK, Guajardo JR. Chylothorax in Henoch-Schonlein purpura: a case report and review of the literature. Pediatr. Pulmonol. 2005;39:563–567
  53. Rocha G, Fernandes P, Rocha P, Quintas C, Martins T, Proenca E. Pleural effusions in the neonate. Acta Paediatr. 2006;95:791–798
  54. Massie J, Pillarisetti N, Ranganathan S. No role for routine CT scans in paediatric empyemas. Thorax. 2008;63:1028–1029
  55. Sharma R, Wendt JA, Rasmussen JC, Adams KE, Marshall MV, Sevick-Muraca EM. New horizons for imaging lymphatic function. Ann. N. Y. Acad. Sci. 2008;1131:13–36
  56. Guermazi A, Brice P, Hennequin C, Sarfati E. Lymphography: an old technique retains its usefulness. Radiographics. 2003;23:1541–1558discussion 1559-60
  57. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J. Thorac. Cardiovasc. Surg. 1996;112:1361–1365discussion 1365-6
  58. Pui MH, Yueh TC. Lymphoscintigraphy in chyluria, chyloperitoneum and chylothorax. J. Nucl. Med. 1998;39:1292–1296
  59. Bellini C, Boccardo F, Campisi C, Villa G, Taddei G, Traggiai C, et al. Lymphatic dysplasias in newborns and children: the role of lymphoscintigraphy. J. Pediatr. 2008;152:587–589
  60. Ruehm SG, Schroeder T, Debatin JF. Interstitial MR lymphography with gadoterate meglumine: initial experience in humans. Radiology. 2001;220:816–821
  61. Clement O, Luciani A. Imaging the lymphatic system: possibilities and clinical applications. Eur. Radiol. 2004;14:1498–1507
  62. Nguyen DM, Shum-Tim D, Dobell AR, Tchervenkov CI. The management of chylothorax/chylopericardium following pediatric cardiac surgery: a 10-year experience. J. Card. Surg. 1995;10:302–308
  63. Helin RD, Angeles STV, Bhat R. Octreotide therapy for chylothorax in infants and children: A brief review. [see comment]. Pediatr Crit Care Med. 2006;7:576–579
  64. Rosti L, De Battisti F, Butera G, Cirri S, Chessa M, Delogu A, et al. Octreotide in the management of postoperative chylothorax. Pediatr. Cardiol. 2005;26:440–443
  65. Roehr CC, Jung A, Proquitte H, Blankenstein O, Hammer H, Lakhoo K, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006;32:650–657
  66. Buettiker V, Hug MI, Burger R, Baenziger O. Somatostatin: a new therapeutic option for the treatment of chylothorax. Intensive Care Med. 2001;27:1083–1086
  67. Lam JCA, Sara , Tobias , Joseph D. Initial Experience with Octreotide in the Pediatric Population. Am. J. Ther. 2001;8:409–415
  68. Kalomenidis I. Octreotide and chylothorax. Curr. Opin. Pulm. Med. 2006;12:264–267
  69. Rosti L, Bini RM, Chessa M, Butera G, Drago M, Carminati M. The effectiveness of octreotide in the treatment of post-operative chylothorax. Eur. J. Pediatr. 2002;161:149–150
  70. Guillem P, Papachristos I, Peillon C, Triboulet J. Etilefrine use in the management of post-operative chyle leaks in thoracic surgery. Interact Cardiovasc Thorac Surg. 2004;3:156–160
  71. Graham DD, McGahren ED, Tribble CG, Daniel TM, Rodgers BM. Use of video-assisted thoracic surgery in the treatment of chylothorax. Ann. Thorac. Surg. 1994;57:1507–1511discussion 1511-2
  72. Achildi O, Smith BP, Grewal H. Thoracoscopic Ligation of the Thoracic Duct in a Child with Spontaneous Chylothorax doi:10.1089/lap.2006.16.546. Journal of Laparoendoscopic & Advanced Surgical Techniques 2006; 16:546-549.
  73. Robinson CL. The management of chylothorax. Ann. Thorac. Surg. 1985;39:90–95
  74. Platis IE, Nwogu CE. Chylothorax. Thorac Surg Clin. 2006;16:209–214
  75. Brissaud O, Desfrere L, Mohsen R, Fayon M, Demarquez JL. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine). [see comment]. Archives of Disease in Childhood Fetal & Neonatal Edition. 2003;88:F531–F533
  76. Noel AA, Gloviczki P, Bender CE, Whitley D, Stanson AW, Deschamps C. Treatment of symptomatic primary chylous disorders. J. Vasc. Surg. 2001;34:785–791
  77. Engum SA, Rescorla FJ, West KW, Scherer LR, Grosfeld JL. The use of pleuroperitoneal shunts in the management of persistent chylothorax in infants. J. Pediatr. Surg. 1999;34:286–290
  78. Wolff AB, Silen ML, Kokoska ER, Rodgers BM. Treatment of refractory chylothorax with externalized pleuroperitoneal shunts in children. Ann. Thorac. Surg. 1999;68:1053–1057
  79. Cope C. Management of chylothorax via percutaneous embolization. Curr. Opin. Pulm. Med. 2004;10:311–314
  80. Jorgensen C, Brocks V, Bang J, Jorgensen FS, Ronsbro L. Treatment of severe fetal chylothorax associated with pronounced hydrops with intrapleural injection of OK-432. Ultrasound Obstet. Gynecol. 2003;21:66–69
  81. Rostom AY. Treatment of thoracic lymphangiomatosis. Arch. Dis. Child. 2000;83:138–139
  82. Bernet-Buettiker V, Waldvogel K, Cannizzaro V, Albisetti M. Antithrombin activity in children with chylothorax. Eur. J. Cardiothorac. Surg. 2006;29:406–409
  83. Wasmuth-Pietzuch A, Hansmann M, Bartmann P, Heep A. Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr. 2004;93:220–224
  84. Orange JS, Geha RS, Bonilla FA. Acute chylothorax in children: selective retention of memory T cells and natural killer cells. J. Pediatr. 2003;143:243–249

PII: S1526-0542(09)00050-5

doi: 10.1016/j.prrv.2009.06.008

Paediatric Respiratory Reviews
Volume 10, Issue 4 , Pages 199-207 , December 2009

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