The Thoracic Duct and Chylothorax
Key Points
- Chylothorax is an accumulation of lymphatic fluid within the pleural space secondary to injury or obstruction of the thoracic duct or an associated or accessory ductal branch.
- Chylothorax is characterized by rapid accumulation of milky fluid after the patient begins a normal diet.
- A pleural fluid triglyceride level > 110 mg/dl is diagnostic.
- The most common causes of chylothorax are iatrogenic injury to the thoracic duct system or spontaneous duct rupture from a neoplastic process.
- The basics of conservative therapy include drainage of the effusion and initiation of a low triglyceride diet or nothing by mouth (nil per os; NPO) with total parenteral nutrition (TPN).
- Interventional radiologic thoracic duct coil embolization is an effective option prior to surgery.
- Prompt surgical ligation of the thoracic duct needs to be performed if nonsurgical modalities fail.
- Modern techniques of thoracic duct identification using indocyanine green (ICG) fluorescence have been proposed to avoid iatrogenic chylothorax.
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Last updated: June 1, 2023
Citation
Singh, Sarah, et al. "The Thoracic Duct and Chylothorax." Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book, Chicago: Society of Thoracic Surgeons, 2023. STS Surgery, ebook.sts.org.
Singh S, Humphrey S, Cooke DT. The Thoracic Duct and Chylothorax. In: Darling GE, Baumgartner WA, Jacobs JP, eds. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2023. ebook.sts.org. Accessed December 5, 2023.
Singh, S., Humphrey, S., & Cooke, D. T. (2023). The Thoracic Duct and Chylothorax. In Darling, G., Baumgartner, W., & Jacobs, J. (Eds.), Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons. ebook.sts.org
Singh S, Humphrey S, Cooke DT. The Thoracic Duct and Chylothorax [Internet]. In: Darling GE, Baumgartner WA, Jacobs JP, editors. Pearson's General Thoracic Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons; 2023. [cited 2023 December 05]. Available from: ebook.sts.org.
* Article titles in AMA citation format should be in sentence-case
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T1 - The Thoracic Duct and Chylothorax
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A1 - Singh,Sarah,MD
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ED - Darling,Gail,
ED - Baumgartner,William,
Y1 - 2023/06/01/
BT - Pearson's General Thoracic
UR - https://ebook.sts.org/sts/view/Pearsons-General-Thoracic/1418484/2.5/The_Thoracic_Duct_and_Chylothorax
PB - Chicago: Society of Thoracic Surgeons
DB - STS Surgery
DP - Unbound Medicine
ER -