Understanding and Treating Chylothorax

Chylothorax, which is the accumulation of lymphatic fluid, or chyle, in the pleural space, occurs most commonly after thoracic surgery. Although it is rare, chylothorax has devastating consequences if not recognized early and managed appropriately. The standard diagnostic approach is the identification of triglycerides and chylomicrons in the pleural fluid. Conservative management consists of reducing chyle flow via complete elimination of fat intake or lessening chyle production with use of octreotide or somatostatin. Surgical treatment is indicated based on lack of response to conservative management. Interventional management techniques are currently evolving. An understanding of the pathophysiology of the chyle leak will inform the diagnosis and management of chylothorax. Overall, conservative management of this serious condition is quite successful.