The Annals of Thoracic Surgery, Vol 31, 520-526, Copyright © 1981 by The Society of Thoracic Surgeons
Management of nontraumatic chylothorax
JL Strausser and MW Flye
Twenty-two patients with chylothorax have been treated at the National
Institutes of Health since 1955. In 9 of these patients, the condition
resulted from an antecedent operation and in 13, it occurred without a
history of prior operation (nontraumatic). All 6 of the patients with
tumors in whom nontraumatic chylothorax developed had a lymphoma. Four of
these 6 also had a chylous ascites, while 6 of the 7 patients without
tumors had an associated chylous ascites. Only 3 of the 13 patients with
nontraumatic chylothorax responded to nonoperative therapy alone with
stabilization of the pleural effusions. A single patient with systemic
lupus erythematosus responded to steroid therapy. In contrast, 3 of 4
patients who underwent thoracotomy for nontraumatic chylothorax had
permanent relief of their chylous pleural effusions. In the absence of
medically treatable disease, thoracotomy with ligation of the thoracic duct
and/or pleurectomy or pleurodesis can provide substantial palliation for
patients with nontraumatic chylothorax, even when a discrete source of
lymph leakage cannot be localized or ascites is present. Early surgical
therapy of nontraumatic chylothorax is advocated in such circumstances.
