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Chylothorax
Randy R. Richardson, MD; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Chylous fluid in pleural space
        • Definitions

          • Lymphatic fluid in pleural space secondary to congenital or acquired conditions, including obstruction, congenital anomaly, increased pressure, impaired drainage, or trauma to thoracic duct
            • Thoracic duct is major central lymphatic vessel
            • Extends in paraspinal tissues from cisterna chyli to point of drainage into left subclavian/brachiocephalic vein
            • Drains lymph from lower limbs, pelvis, abdomen

        IMAGING

        • General Features

          • Radiographic Findings

            • Ultrasonographic Findings

              • CT Findings

                • Lymphangiogram

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    Selected References

                                    1. Brock WW et al: Congenital chylothorax: a unique presentation of nonimmune hydrops fetalis in a preterm infant. Adv Neonatal Care. 16(2):114-23, 2016
                                    2. Bang JH et al: Anatomic variability of the thoracic duct in pediatric patients with complex congenital heart disease. J Thorac Cardiovasc Surg. 150(3):490-5, 2015
                                    3. Bialkowski A et al: Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed. 100(2):F169-72, 2015
                                    4. Krishnamurthy R et al: Imaging the central conducting lymphatics: initial experience with dynamic MR lymphangiography. Radiology. 274(3):871-8, 2015
                                    5. Bengtsson BO: Outcome of neonatal chylous effusions: what do you tell the parents? A 10-year experience in a community hospital. Am J Perinatol. 31(12):1037-42, 2014
                                    6. Downie L et al: Congenital chylothorax: associations and neonatal outcomes. J Paediatr Child Health. 50(3):234-8, 2014
                                    7. Gray M et al: Treatment of congenital pulmonary lymphangiectasia using ethiodized oil lymphangiography. J Perinatol. 34(9):720-2, 2014
                                    8. Lomauri Kh: Congenital chylothorax in newborn with trisomy 21. Georgian Med News. 74-7, 2014
                                    9. Lopez-Gutierrez JC et al: Chylothorax and chylous ascites: management and pitfalls. Semin Pediatr Surg. 23(5):298-302, 2014
                                    10. Trenor CC 3rd et al: Complex lymphatic anomalies. Semin Pediatr Surg. 23(4):186-90, 2014
                                    11. Nadolski GJ et al: Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients. Chest. 143(1):158-63, 2013
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Synonyms

                                            • Chylous fluid in pleural space
                                          • Definitions

                                            • Lymphatic fluid in pleural space secondary to congenital or acquired conditions, including obstruction, congenital anomaly, increased pressure, impaired drainage, or trauma to thoracic duct
                                              • Thoracic duct is major central lymphatic vessel
                                              • Extends in paraspinal tissues from cisterna chyli to point of drainage into left subclavian/brachiocephalic vein
                                              • Drains lymph from lower limbs, pelvis, abdomen

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • Ultrasonographic Findings

                                                • CT Findings

                                                  • Lymphangiogram

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      Selected References

                                                                      1. Brock WW et al: Congenital chylothorax: a unique presentation of nonimmune hydrops fetalis in a preterm infant. Adv Neonatal Care. 16(2):114-23, 2016
                                                                      2. Bang JH et al: Anatomic variability of the thoracic duct in pediatric patients with complex congenital heart disease. J Thorac Cardiovasc Surg. 150(3):490-5, 2015
                                                                      3. Bialkowski A et al: Congenital chylothorax: a prospective nationwide epidemiological study in Germany. Arch Dis Child Fetal Neonatal Ed. 100(2):F169-72, 2015
                                                                      4. Krishnamurthy R et al: Imaging the central conducting lymphatics: initial experience with dynamic MR lymphangiography. Radiology. 274(3):871-8, 2015
                                                                      5. Bengtsson BO: Outcome of neonatal chylous effusions: what do you tell the parents? A 10-year experience in a community hospital. Am J Perinatol. 31(12):1037-42, 2014
                                                                      6. Downie L et al: Congenital chylothorax: associations and neonatal outcomes. J Paediatr Child Health. 50(3):234-8, 2014
                                                                      7. Gray M et al: Treatment of congenital pulmonary lymphangiectasia using ethiodized oil lymphangiography. J Perinatol. 34(9):720-2, 2014
                                                                      8. Lomauri Kh: Congenital chylothorax in newborn with trisomy 21. Georgian Med News. 74-7, 2014
                                                                      9. Lopez-Gutierrez JC et al: Chylothorax and chylous ascites: management and pitfalls. Semin Pediatr Surg. 23(5):298-302, 2014
                                                                      10. Trenor CC 3rd et al: Complex lymphatic anomalies. Semin Pediatr Surg. 23(4):186-90, 2014
                                                                      11. Nadolski GJ et al: Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients. Chest. 143(1):158-63, 2013