Clinical Charactesistics and Surgical Treatment of Chylothorax

Abstract

Major lymphatic drainage system in the body is the thoracic duct. While this duct carries liquid and digested fats into the systemic circulation, outside the vascular system it makes the proteins return to the blood again. Any interruption, occlusion, or dysfunction in the flow of chylous fluid in the thoracic duct causes chylothorax. Chylothorax is a fatal disease and needs to be treated. For this reason, surgical treatment options with its etiology and diagnosis have been aimed. It has non-traumatic and traumatic etiology (iatrogenic, blunt trauma or penetrating injury). The ratios of chylothorax are traumatic 50%, non-traumatic 44% and idiopathic 6%. Medical and surgical interventions applied to lungs, trachea, mediastinum, cardiovascular, aorta, neck, esophagus, diaphragm, stomach and vertebral bodies traumatic chylothorax causes. Esophagectomy and congenital heart disease surgical treatments are the most common causes of surgical traumatic chylothorax. Increased intra-thoracic or intraabdominal pressure, blunt trauma, give birth, stretching, sneezing, vomiting, seat belts and thoracolumbosacral orthosis are among the causes of non-surgical traumatic chylothorax. Chest radiography does not give detailed information about the etiology of chylothorax. Trauma areas in the lymphatic system, mediastinal lymph nodes, tumoral lesions can be detected in thorax CT. Pleural fluid analysis obtained by thoracentesis has important place in the diagnosis of chylothorax. If the triglyceride is> 110 mg / dL in the pleural fluid, this fluid is 99% chylous fluid. The most important criterion is that the pleural fluid cholesterol / triglyceride ratio is <1. The first step of surgical treatment in chylothorax is usually the application of tube thoracostomy. Drainage is usually almost always used to re-dilate the lung and take advantage of compression effects. If there is no response to conservative treatments, surgical treatment are initiated. Surgical procedures are drainage by tube thoracostomy, pleurodesis, duct ligation with video-assisted thoracoscopic surgery or thoracotomy, transabdominal thoracic duct mass ligation, and intraabdominal cisterna chyli ligation. The most significant health problem in patients with chylothorax is the loss in the lymphatic system. During the course and treatment of the disease, electrolyte, fat, protein, vitamin and fluid losses should be replaced. Due to the loss of T cells in the lymphatic fluid, there is a high probability of immunodeficiency and malnutrition in patients receiving long-term therapy. Since the main causes of death in chylothorax are malnutrition, infection and immunodeficiency, it should be treated immediately.