Multidisciplinary Management of Chylothorax

Chest. 2022 Dec;162(6):1402-1412. doi: 10.1016/j.chest.2022.06.012. Epub 2022 Jun 20.


Chylothorax, the accumulation of chyle in the pleural space, is usually caused by the disruption of the thoracic duct or its tributaries. Etiologies are broadly divided into traumatic, including postsurgical, and nontraumatic, most commonly in the setting of malignancy. The management of chylothorax largely depends on the cause and includes dietary modification and drainage of the pleural space. A definitive intervention, whether surgical or a percutaneous lymphatic intervention, should be considered in patients with a persistently high volume of chylous output and in those with a prolonged leak, before complications such as malnutrition ensue. No methodologically robust clinical trials guiding management are currently available. In this article, we review the current literature and propose a stepwise, evidence-based multidisciplinary approach to the management of patients with both traumatic and nontraumatic chylothorax.

Keywords: chylothorax; pleural effusion; thoracic duct embolization; thoracic duct ligation.

Publication types

  • Review

MeSH terms

  • Chylothorax* / diagnosis
  • Chylothorax* / etiology
  • Chylothorax* / therapy
  • Humans
  • Thoracic Duct / surgery