Medical and surgical management of chylothorax and associated outcomes

Fabien Maldonado, Rodrigo Cartin-Ceba, Finn J. Hawkins, Jay H Ryu

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Chylothorax is an uncommon form of pleural effusion that can be associated with traumatic and nontraumatic causes. Optimal management and outcome for patients with chylothorax remain unclear. This retrospective single-center study assessed the modes of management for chylothorax in 74 adult patients (≥18 years old) and associated outcomes. The role of lymphangiographic imaging was also evaluated. Initial treatment approach was nonsurgical in 57 patients (77%) but a surgical procedure (pleurodesis, thoracic duct ligation, and/or surgical repair) was eventually performed in 44 patients (59%). The rate of resolution with initial treatment measures was significantly worse for patients with nontraumatic chylothorax compared with those with traumatic causes (27% versus 50%, P = 0.048). Even after additional therapeutic maneuvers including surgery, chylous effusion recurred more commonly in nontraumatic chylothorax when compared with the traumatic group (50% versus 13%, respectively, P < 0.001). Lymphatic imaging did not seem to materially influence management. Nonsurgical approaches may lead to resolution of the chylothorax in nearly one half of patients with traumatic chylothorax but in only a minority of those with nontraumatic chylothorax. The majority of patients with nontraumatic chylothorax will eventually require surgical maneuvers, but one third of such patients still fail to resolve their chylothorax.

Original languageEnglish (US)
Pages (from-to)314-318
Number of pages5
JournalAmerican Journal of the Medical Sciences
Volume339
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

Chylothorax
Pleurodesis
Thoracic Duct
Pleural Effusion
Ligation
Therapeutics

Keywords

  • Chylothorax
  • Pleural effusion
  • Pleurodesis
  • Thoracic duct ligation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Medical and surgical management of chylothorax and associated outcomes. / Maldonado, Fabien; Cartin-Ceba, Rodrigo; Hawkins, Finn J.; Ryu, Jay H.

In: American Journal of the Medical Sciences, Vol. 339, No. 4, 04.2010, p. 314-318.

Research output: Contribution to journalArticle

Maldonado, Fabien ; Cartin-Ceba, Rodrigo ; Hawkins, Finn J. ; Ryu, Jay H. / Medical and surgical management of chylothorax and associated outcomes. In: American Journal of the Medical Sciences. 2010 ; Vol. 339, No. 4. pp. 314-318.
@article{edce60dff70a4cc29e92ab9c2934daac,
title = "Medical and surgical management of chylothorax and associated outcomes",
abstract = "Chylothorax is an uncommon form of pleural effusion that can be associated with traumatic and nontraumatic causes. Optimal management and outcome for patients with chylothorax remain unclear. This retrospective single-center study assessed the modes of management for chylothorax in 74 adult patients (≥18 years old) and associated outcomes. The role of lymphangiographic imaging was also evaluated. Initial treatment approach was nonsurgical in 57 patients (77{\%}) but a surgical procedure (pleurodesis, thoracic duct ligation, and/or surgical repair) was eventually performed in 44 patients (59{\%}). The rate of resolution with initial treatment measures was significantly worse for patients with nontraumatic chylothorax compared with those with traumatic causes (27{\%} versus 50{\%}, P = 0.048). Even after additional therapeutic maneuvers including surgery, chylous effusion recurred more commonly in nontraumatic chylothorax when compared with the traumatic group (50{\%} versus 13{\%}, respectively, P < 0.001). Lymphatic imaging did not seem to materially influence management. Nonsurgical approaches may lead to resolution of the chylothorax in nearly one half of patients with traumatic chylothorax but in only a minority of those with nontraumatic chylothorax. The majority of patients with nontraumatic chylothorax will eventually require surgical maneuvers, but one third of such patients still fail to resolve their chylothorax.",
keywords = "Chylothorax, Pleural effusion, Pleurodesis, Thoracic duct ligation",
author = "Fabien Maldonado and Rodrigo Cartin-Ceba and Hawkins, {Finn J.} and Ryu, {Jay H}",
year = "2010",
month = "4",
doi = "10.1097/MAJ.0b013e3181cdcd6c",
language = "English (US)",
volume = "339",
pages = "314--318",
journal = "American Journal of the Medical Sciences",
issn = "0002-9629",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Medical and surgical management of chylothorax and associated outcomes

AU - Maldonado, Fabien

AU - Cartin-Ceba, Rodrigo

AU - Hawkins, Finn J.

AU - Ryu, Jay H

PY - 2010/4

Y1 - 2010/4

N2 - Chylothorax is an uncommon form of pleural effusion that can be associated with traumatic and nontraumatic causes. Optimal management and outcome for patients with chylothorax remain unclear. This retrospective single-center study assessed the modes of management for chylothorax in 74 adult patients (≥18 years old) and associated outcomes. The role of lymphangiographic imaging was also evaluated. Initial treatment approach was nonsurgical in 57 patients (77%) but a surgical procedure (pleurodesis, thoracic duct ligation, and/or surgical repair) was eventually performed in 44 patients (59%). The rate of resolution with initial treatment measures was significantly worse for patients with nontraumatic chylothorax compared with those with traumatic causes (27% versus 50%, P = 0.048). Even after additional therapeutic maneuvers including surgery, chylous effusion recurred more commonly in nontraumatic chylothorax when compared with the traumatic group (50% versus 13%, respectively, P < 0.001). Lymphatic imaging did not seem to materially influence management. Nonsurgical approaches may lead to resolution of the chylothorax in nearly one half of patients with traumatic chylothorax but in only a minority of those with nontraumatic chylothorax. The majority of patients with nontraumatic chylothorax will eventually require surgical maneuvers, but one third of such patients still fail to resolve their chylothorax.

AB - Chylothorax is an uncommon form of pleural effusion that can be associated with traumatic and nontraumatic causes. Optimal management and outcome for patients with chylothorax remain unclear. This retrospective single-center study assessed the modes of management for chylothorax in 74 adult patients (≥18 years old) and associated outcomes. The role of lymphangiographic imaging was also evaluated. Initial treatment approach was nonsurgical in 57 patients (77%) but a surgical procedure (pleurodesis, thoracic duct ligation, and/or surgical repair) was eventually performed in 44 patients (59%). The rate of resolution with initial treatment measures was significantly worse for patients with nontraumatic chylothorax compared with those with traumatic causes (27% versus 50%, P = 0.048). Even after additional therapeutic maneuvers including surgery, chylous effusion recurred more commonly in nontraumatic chylothorax when compared with the traumatic group (50% versus 13%, respectively, P < 0.001). Lymphatic imaging did not seem to materially influence management. Nonsurgical approaches may lead to resolution of the chylothorax in nearly one half of patients with traumatic chylothorax but in only a minority of those with nontraumatic chylothorax. The majority of patients with nontraumatic chylothorax will eventually require surgical maneuvers, but one third of such patients still fail to resolve their chylothorax.

KW - Chylothorax

KW - Pleural effusion

KW - Pleurodesis

KW - Thoracic duct ligation

UR - http://www.scopus.com/inward/record.url?scp=77950955473&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950955473&partnerID=8YFLogxK

U2 - 10.1097/MAJ.0b013e3181cdcd6c

DO - 10.1097/MAJ.0b013e3181cdcd6c

M3 - Article

C2 - 20124878

AN - SCOPUS:77950955473

VL - 339

SP - 314

EP - 318

JO - American Journal of the Medical Sciences

JF - American Journal of the Medical Sciences

SN - 0002-9629

IS - 4

ER -