Therapeutic Strategies for Idiopathic Chylothorax

J Pediatr Surg. 2008 Mar;43(3):461-5. doi: 10.1016/j.jpedsurg.2007.10.024.

Abstract

Study objectives: The objectives of the study were to present our institutional experience of idiopathic chylothorax in children and to propose therapeutic strategies.

Design: This was a retrospective, single-center study.

Patients: Patients were 6 children (4 boys, 2 girls) presenting with an idiopathic chylothorax diagnosed from the presence of a chylous pleural effusion with triglycerides greater than 1.2 mmol/L and a cellularity greater than 1000 cells/mL with a predominance of lymphocytes.

Results: Median age of onset was 7 years (range, 2-14 years). Initial symptoms included cough (n = 4), tachypnea (n = 4), asthenia (n = 5), abdominal pain (n = 2), and bronchitis (n = 1). Chest radiography showed 2 left, 2 right, and 2 bilateral pleural effusions. Serum biology assessment was normal in all children. Respiratory function assessment at diagnosis revealed a decrease in functional residual capacity in 3 children and a decrease in lung diffusing capacity in 2 children. Initially, all patients received a medium-chain triglyceride diet for 29 months (range, 10-50 months). Total parenteral nutrition was required for 4 patients (for 1-4 months), and somatostatin was tried in one child. Two children required pleuroperitoneal shunting, bilateral in one case. During the follow-up (median duration, 6 years; range, 2-16 years), chylothorax stabilized in all patients and 5 patients were able to return to a normal diet.

Conclusion: A medium-chain triglyceride diet associated in some cases with total parenteral nutrition may stabilize idiopathic chylothorax in children. In cases where conservative treatment has failed, pleuroperitoneal shunting may be useful.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Chylothorax / diagnosis*
  • Chylothorax / therapy*
  • Combined Modality Therapy
  • Diet, Fat-Restricted*
  • Drainage / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Parenteral Nutrition / methods
  • Pleural Effusion / diagnosis
  • Pleural Effusion / therapy
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome