Chylothorax_Presentation_Red.pptxtreartm

Chylothorax

1. Chylothorax - Overview Definition: Accumulation of lymphatic fluid (chyle) in the pleural space due to disruption or obstruction of the thoracic duct. Composition: Milky, odorless fluid rich in triglycerides, lymphocytes, and chylomicrons. Incidence: Rare but significant postoperative complication in thoracic and cardiac surgery.

2. Etiology & Pathophysiology Causes: - Iatrogenic (post cardiac/thoracic surgery, esophagectomy, trauma) - Malignancy (lymphoma) - Idiopathic (rare) Mechanism: - Injury or obstruction to thoracic duct → leakage of chyle into pleural space - Chyle loss → malnutrition, immunosuppression, electrolyte imbalance

3. Clinical Features & Diagnosis Clinical Features: - Dyspnea, chest fullness - Decreased breath sounds - Milky pleural drainage post-surgery Diagnostic Tests: - Pleural fluid triglycerides >110 mg/dL - Sudan III staining (chylomicrons) - CT / Lymphangiography for site localization

4. Management Conservative: - NPO + Total Parenteral Nutrition (TPN) - Medium Chain Triglyceride (MCT) diet - Octreotide infusion - Pleural drainage Surgical: - Thoracic duct ligation (right side above diaphragm) - Pleurodesis (chemical/mechanical) - Thoracic duct embolization (interventional radiology)

5. Prognosis & Key Points Early diagnosis prevents malnutrition & infection. Surgical ligation indicated if >1L/day drainage persists >5 days. Minimally invasive VATS approach preferred. Prognosis: Excellent with timely intervention. References: - Shields TW. General Thoracic Surgery. - StatPearls: Chylothorax (2024). - Iowa Head & Neck Protocols.