Etiology and management of pediatric chylothorax
Maurice Beghetti, MD
Giorgio La Scala, MD
Dominique Belli, MD
Philippe Bugmann, MD
Afksendiyos Kalangos, MD, PhD
Claude Le Coultre, MD * Correspondence information about the author MD Claude Le Coultre
From the Cardiology Unit, Pediatric Surgery Clinic, Gastroenterology Unit, Department of Pediatrics and the Cardiovascular Surgery Clinic, Department of Surgery, Geneva, Switzerland.
Objectives: To determine the incidence and etiology of chylothorax and to assess our therapeutic management approach.
Study design: We reviewed 51 patients diagnosed with chylothorax over a 12-year period. Cause, interval between operation and diagnosis, duration of chylothorax, and total volume loss per weight were recorded.
Results: Chylothorax was diagnosed in 46 children after cardiothoracic surgery, giving an incidence of 2.59% (46/1842); in 1 child chylothorax occurred after chest trauma, and in 4 the chylothorax was congenital or a manifestation of lymph angiomatosis. Three etiologic groups were identified: group 1, direct injury to the thoracic duct (33/51 = 65%); group 2, thrombosis and/or high venous pressure in the superior vena cava (14/51 = 27%); and group 3, congenital (4/51 = 8%). Conservative treatment was the only treatment in 80% of the patients. Surgical procedures consisted of 4 ligations of the thoracic duct, placement of 7 pleurodesis shunts, and placement of 2 pleuroperitoneal shunts. Patients in groups 2 and 3 were at higher risk for failure of conservative treatment (P < .005). Longer duration of chylothorax and higher volume of drainage were present in group 2 compared with group 1 (P <.01).
Conclusion: Conservative treatment was successful in 80% of the patients with our management approach. Prevention, early recognition, and treatment of potential complications, such as superior vena cava thrombosis or obstruction, may further improve success of conservative treatment. Congenital chylothorax seems different and may require a specific approach.
HVP, High venous pressure, MCTs, Medium-chain triglycerides, SVC, Superior cena cava, TPN, Total parenteral nutrition