Midodrine: a novel therapeutic for refractory chylothorax

Chest. 2013 Sep;144(3):1055-1057. doi: 10.1378/chest.12-3081.


Thoracic duct injury is a rare but serious complication following surgery of the neck or chest that leads to uncontrolled chyle leak. Conventional management includes drainage, nutritional modification, or aggressive surgical interventions such as thoracic duct ligation, flap coverage, fibrin glue, or talc pleurodesis; few successful medical therapeutics are available. We report a case of a high-output chylothorax refractory to aggressive medical and surgical interventions. Chyle output decreased substantially after initiating midodrine, an α1-adrenergic agonist that causes vasoconstriction of the lymph system, reducing chyle flow. This case report suggests that midodrine may be a novel therapeutic for refractory chyle leaks.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / surgery
  • Chylothorax / drug therapy*
  • Chylothorax / etiology
  • Chylothorax / surgery
  • Esophageal Neoplasms / surgery
  • Esophagectomy / adverse effects
  • Female
  • Follow-Up Studies
  • Humans
  • Ligation
  • Middle Aged
  • Midodrine / therapeutic use*
  • Thoracic Duct / injuries*
  • Thoracic Duct / surgery
  • Vasoconstrictor Agents / therapeutic use*


  • Vasoconstrictor Agents
  • Midodrine

Supplementary concepts

  • Adenocarcinoma Of Esophagus