The Thoracic Duct and Chylothorax

Sterling Humphrey, David Tom Cooke

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 accesory 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.

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Last updated: April 8, 2020