Skip to main content
SpringerLink
Log in

Medical Management

  • Chapter
  • First Online:
Lymphedema

  • 1883 Accesses

Abstract

Chylorrhea (“Chyle leak”) occurs when chyle (see Table 54.1), a milky, triglyceride-rich liquid, extravasates, most commonly into the peritoneal cavity (chylous ascites) or ­pleural space (chyloperitoneum). Chyle leakage can also result in chyluria (chyle in the urine), chyloptysis (chyle in the sputum), chylopericardium, or cutaneous chyle leakage.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Spain D, McCLure S. Chylothorax and chyous ascites. In: Gottschlich M, Fuhrman M, Hammond K, eds. The Science and Practice of Nutrition Support: A Case-Based Core Curriculum. Dubuque: Kendall/Hunt Publishing; 2000:479-489.

    Google Scholar 

  2. McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med. 2010;104(1):1-8.

    Article  PubMed  Google Scholar 

  3. Teichgraber UK, Nibbe L, Gebauer B, Wagner HJ. Inadvertent puncture of the thoracic duct during attempted central venous catheter placement. Cardiovasc Intervent Radiol. 2003;26(6):569-571.

    Article  PubMed  Google Scholar 

  4. Fishman SJ, Burrows PE, Upton J, Hendren WH. Life-threatening anomalies of the thoracic duct: anatomic delineation dictates management. J Pediatr Surg. 2001;36(8):1269-1272.

    Article  PubMed  CAS  Google Scholar 

  5. Soto-Martinez M, Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009;10(4):199-207.

    Article  PubMed  Google Scholar 

  6. Lim KG, Rosenow EC 3rd, Staats B, Couture C, Morgenthaler TI. Chyloptysis in adults: presentation, recognition, and differential diagnosis. Chest. 2004;125(1):336-340.

    Article  PubMed  Google Scholar 

  7. Le Pimpec-Arthes F, Badia A, Febvre M, Legman P, Riquet M. Chylous reflux into localized pulmonary lymphangiectasis. Ann Thorac Surg. 2002;74(2):575-578.

    Article  PubMed  Google Scholar 

  8. Sashida Y, Nishizeki O, Higaonna K, Arashiro K. Blunt thoracic duct injury in the neck diagnosed by lymphoscintigraphy. J Plast Reconstr Aesthet Surg. 2008;61(9):1114-1115.

    Article  PubMed  Google Scholar 

  9. Shackcloth MJ, Poullis M, Lu J, Page RD. Preventing of chylothorax after oesophagectomy by routine pre-operative administration of oral cream. Eur J Cardiothorac Surg. 2001;20(5):1035-1036.

    Article  PubMed  CAS  Google Scholar 

  10. Dendale J, Comet P, Amram D, Lesbros D. Prenatal diagnosis of chylothorax. Arch Pediatr. 1999;6(8):867-871.

    Article  PubMed  CAS  Google Scholar 

  11. Caserio S, Gallego C, Martin P, Moral M, Pallas C, Galindo A. Congenital chylothorax: from foetal life to adolescence. Acta Paediatr. 2010;99(10):1571-1577.

    Article  PubMed  CAS  Google Scholar 

  12. Ergaz Z, Bar-Oz B, Yatsiv I, Arad I. Congenital chylothorax: clinical course and prognostic significance. Pediatr Pulmonol. 2009;44(8):806-811.

    Article  PubMed  Google Scholar 

  13. Gaba RC, Owens CA, Bui JT, Carrillo TC, Knuttinen MG. Chylous ascites: a rare complication of thoracic duct embolization for chylothorax. Cardiovasc Intervent Radiol. 2010;34(suppl 2):245-249.

    Google Scholar 

  14. Ferrandiere M, Hazouard E, Guicheteau V, et al. Chylous ascites following radical nephrectomy: efficiency of octreotide as treatment of a ruptured thoracic duct. Intensive Care Med. 2000;26(4):484-485.

    Article  PubMed  CAS  Google Scholar 

  15. Ulibarri JI, Sanz Y, Fuentes C, Mancha A, Aramendia M, Sanchez S. Reduction of lymphorrhagia from ruptured thoracic duct by somatostatin. Lancet. 1990;336(8709):258.

    Article  PubMed  CAS  Google Scholar 

  16. Bliss CM, Schroy IP. Primary intestinal lymphangiectasia. Curr Treat Options Gastroenterol. 2004;7(1):3-6.

    Article  PubMed  Google Scholar 

  17. Maayan-Metzger A, Sack J, Mazkereth R, Vardi A, Kuint J. Somatostatin treatment of congenital chylothorax may induce transient hypothyroidism in newborns. Acta Paediatr. 2005;94(6):785-789.

    Article  PubMed  Google Scholar 

  18. Chan SY, Lau W, Wong WH, Cheng LC, Chau AK, Cheung YF. Chylothorax in children after congenital heart surgery. Ann Thorac Surg. 2006;82(5):1650-1656.

    Article  PubMed  Google Scholar 

  19. Siu SL, Lam DS. Spontaneous neonatal chylothorax treated with octreotide. J Paediatr Child Health. 2006;42(1–2):65-67.

    Article  PubMed  Google Scholar 

  20. Barili F, Polvani G, Topkara VK, et al. Administration of octreotide for management of postoperative high-flow chylothorax. Ann Vasc Surg. 2007;21(1):90-92.

    Article  PubMed  Google Scholar 

  21. Mincher L, Evans J, Jenner MW, Varney VA. The successful treatment of chylous effusions in malignant disease with octreotide. Clin Oncol (R Coll Radiol). 2005;17(2):118-121.

    CAS  Google Scholar 

  22. Panthongviriyakul C, Bines JE. Post-operative chylothorax in children: an evidence-based management algorithm. J Paediatr Child Health. 2008;44(12):716-721.

    Article  PubMed  Google Scholar 

  23. Pratap U, Slavik Z, Ofoe VD, Onuzo O, Franklin RC. Octreotide to treat postoperative chylothorax after cardiac operations in children. Ann Thorac Surg. 2001;72(5):1740-1742.

    Article  PubMed  CAS  Google Scholar 

  24. Valentine CN, Barresi R, Prinz RA. Somatostatin analog treatment of a cervical thoracic duct fistula. Head Neck. 2002;24(8):810-813.

    Article  PubMed  Google Scholar 

  25. Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendick PJ. Octreotide in the treatment of thoracic duct injuries. Am Surg. 2000;66(12):1165-1167.

    PubMed  CAS  Google Scholar 

  26. Bulbul A, Unsur EK. Octreotide as a treatment of congenital chylothorax. Pediatr Pulmonol. 2010;45(6):628. author reply 9–30.

    PubMed  Google Scholar 

  27. Rosing DK, Smith BR, Konyalian V, Putnam B. Penetrating traumatic thoracic duct injury treated successfully with octreotide therapy. J Trauma. 2009;67(1):E20-E21.

    Article  PubMed  Google Scholar 

  28. Takahashi M, Kurokawa Y, Toyama H, Hasegawa R, Hashimoto Y. The successful management of thoracoscopic thoracic duct ligation in a compromised infant with targeted lobar deflation. Anesth Analg. 2001;93(1):96-97.

    Article  PubMed  CAS  Google Scholar 

  29. Chen M, Chen CP, Shih JC, et al. Antenatal treatment of chylothorax and cystic hygroma with OK-432 in nonimmune hydrops fetalis. Fetal Diagn Ther. 2005;20(4):309-315.

    Article  PubMed  Google Scholar 

  30. Nygaard U, Sundberg K, Nielsen HS, Hertel S, Jorgensen C. New treatment of early fetal chylothorax. Obstet Gynecol. 2007;109(5):1088-1092.

    Article  PubMed  CAS  Google Scholar 

  31. Matsukuma E, Aoki Y, Sakai M, et al. Treatment with OK-432 for persistent congenital chylothorax in newborn infants resistant to octreotide. J Pediatr Surg. 2009;44(3):e37-e39.

    Article  PubMed  Google Scholar 

  32. Guillem P, Papachristos I, Peillon C, Triboulet JP. Etilefrine use in the management of post-operative chyle leaks in thoracic surgery. Interact Cardiovasc Thorac Surg. 2004;3(1):156-160.

    Article  PubMed  Google Scholar 

  33. Ohara T, Oto T, Miyoshi K, et al. Sirolimus ameliorated post lung transplant chylothorax in lymphangioleiomyomatosis. Ann Thorac Surg. 2008;86(6):e7-e8.

    Article  PubMed  Google Scholar 

  34. Shigemura N, Kawamura T, Minami M, et al. Successful factor XIII administration for persistent chylothorax after lung transplantation for lymphangioleiomyomatosis. Ann Thorac Surg. 2009;88(3):1003-1006.

    Article  PubMed  Google Scholar 

  35. Repko BM, Scorza LB, Mahraj RP. Recurrent chylothorax after neck surgery: percutaneous thoracic duct embolization as primary treatment. Otolaryngol Head Neck Surg. 2009;141(3):426-427.

    Article  PubMed  Google Scholar 

  36. Patel N, Lewandowski RJ, Bove M, Nemcek AA Jr, Salem R. Thoracic duct embolization: a new treatment for massive leak after neck dissection. Laryngoscope. 2008;118(4):680-683.

    Article  PubMed  Google Scholar 

  37. Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg. 2010;139(3):584-589. discussion 9–90.

    Article  PubMed  Google Scholar 

  38. Smoke A, Delegge MH. Chyle leaks: Consensus on management? Nutr Clin Pract. 2008;23(5):529-532.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vascular Birthmark Institute, Roosevelt Hospital, New York, NY, USA

    Francine Blei

Authors
  1. Francine Blei
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. George Washington University, Washington D.C, Washington, USA

    Byung-Boong Lee

  2. School of Medicine, University of California, San Diego, La Jolla, 92037, California, USA

    John Bergan

  3. Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, 94305, USA

    Stanley G. Rockson

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Blei, F. (2011). Medical Management. In: Lee, BB., Bergan, J., Rockson, S. (eds) Lymphedema. Springer, London. https://doi.org/10.1007/978-0-85729-567-5_54

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-567-5_54

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-566-8

  • Online ISBN: 978-0-85729-567-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation