Chylothorax Treatment Planning Revised 2024 ACR Appropriateness Criteria® 1 Chylothorax Treatment Planning American College of Radiology ACR Appropriateness Criteria® Chylothorax Treatment Planning Variant 1: Adult or child. Chylothorax: traumatic or iatrogenic etiology. Pretreatment planning. Procedure Appropriateness Category Relative Radiation Level Lymphangiography chest abdomen pelvis contrast May Be Appropriate ☢☢☢☢☢ CT chest abdomen pelvis without IV contrast May Be Appropriate ☢☢☢☢ US chest Usually Not Appropriate O US chest abdomen pelvis Usually Not Appropriate O ACR Appropriateness Criteria® 2 Chylothorax Treatment Planning Variant 2: Adult or child. Chylothorax: nontraumatic or unknown etiology. Pretreatment planning. Procedure Appropriateness Category Relative Radiation Level
Refractory Chylothorax: Descriptive Analysis and Predictive Model in Children with Postoperative Chylothorax. Chylothorax following pediatric cardiac surgery increases morbidity and mortality. The clinical outcomes of patients with chylothorax with prolonged drainage compared to prompt resolution have not been described. This is a retrospective cohort study across eight United States pediatric cardiac intensive care units (ICU). Patients < 18 years old treated for chylothorax within 30 days of cardiac surgery were included, excluding Fontan palliations. Patients with chest tube duration ≥ 14 days were classified as long chylothorax (LC) vs. < 14 days as short chylothorax (SC). Univariable and multivariable logistic regression modeled patient characteristics associated with LC vs. SC. 134
The association of chylothorax with aggressiveness of lymph node management during pulmonary resection. Chylothorax is a morbid and costly complication that can originate in lymph node resection beds. We hypothesized a close association between the occurrence of chylothorax and the extent/aggressiveness of lymph node dissection. We conducted a nested case-control study of 1728 non-small cell lung cancer patients who underwent resection at our institution January 2005-July 2023. Cases were defined as patients who developed chylothorax. Each case was matched with 3 control subjects who did not develop chylothorax, based on year of diagnosis, clinical N-descriptor, presence of granulomatous lymph nodes, extent of resection, and tumor laterality. Using conditional logistic regression, we
Use of a Postoperative Care Management Pathway Reduces the Incidence of Chylothorax Post-Fontan Palliation. Pleural effusions and chylothorax are challenging morbidities post-Fontan palliation. We sought to evaluate the efficacy of our Fontan Care Pathway (FCP) in reducing the incidence of post-operative chylothorax and Time to Chest Tube Removal (TTCTR), and to determine risk factors associated with longer TTCTR. Between 2016 and 2022 our institutional approach to post-Fontan care fell into three categories: Group 1 (n = 36): no standardized approach; Group 2 (n = 30): a prophylactic chylothorax diet (fat content < 5%); Group 3 (n = 57): the FCP (a chylothorax diet, fluid restriction, supplemental O2 and aggressive diuresis). The incidence of chylothorax and TTCTR was compared between groups
Chylothorax in a Young Woman With Crohn Disease. Chylothorax, which accounts for 1% to 3% of pleural effusions, typically results from either surgery (traumatic) or underlying malignancy (nontraumatic). Less common causes of nontraumatic chylothorax are numerous and include congenital lymphatic abnormalities, connective tissue diseases, cirrhosis, and infection, among others. We describe what appears to be the first reported case of chylothorax caused by chylous ascites in Crohn disease. This case highlights the importance of using diagnostic evidence to link new symptoms to preexisting diseases whenever possible, as well as the systemic nature of Crohn disease.
Multidisciplinary Management of Adult Patients with Chylothorax: A Consensus Statement. The management of chylothorax remains challenging given the limited evidence and significant heterogeneity in practice. In addition, there are no practical guidelines on the optimal approach to manage this complex condition. We convened an international group of 27 experts from 20 institutions across five countries and 4 specialties (Pulmonary, Interventional Radiology, Thoracic Surgery & Nutrition) with experience and expertise in managing adult patients with chylothorax. We performed a literature and internet search for reports addressing 7 clinically relevant questions pertaining to the management of adult patients with chylothorax. This consensus statement, consisting of best practice statements based
Prediction Model with External Validation for Early Detection of Postoperative Pediatric Chylothorax. Earlier diagnosis of chylothorax following pediatric cardiac surgery is associated with decreased duration of chylothorax. Pleural fluid testing is used to diagnosis chylothorax which may delay detection in patients who are not enterally fed at time of chylothorax onset. Our aim was to develop and externally validate a prediction model to detect chylothorax earlier than pleural fluid testing in pediatric patients following cardiac surgery. A multivariable logistic regression model was developed to detect chylothorax using a stepwise approach. The model was developed using data from patients < 18 years following cardiac surgery from Primary Children's Hospital, a tertiary-care academic center
Chylothorax due to hepatic alveolar echinococcosis with infiltration of diaphragm and left pleura: a case report. Alveolar echinococcosis (AE) is an endemic parasitic zoonosis in Germany. In most cases, the liver is the primary organ affected. A 59-year old female patient presented with increasing exertional dyspnea and unintentional weight loss. A computed tomography (CT) scan showed a left
Propranolol Therapy for Congenital Chylothorax. Congenital chylothorax is a rare and often severe anomaly without well-established medical therapies. Previously, propranolol use in patients with lymphatic malformations and secondary chylothorax was associated with improvement in clinical signs. We hypothesized that propranolol treatment would be beneficial for severe congenital chylothorax. We reviewed medical records of neonates born from 2015 to 2019 at our tertiary center with a prenatal diagnosis of congenital chylothorax for whom either prenatal or postnatal propranolol therapy was initiated. Inclusion was limited to fetuses diagnosed with severe congenital chylothorax without significant genetic, infectious, or cardiac anomalies, and who underwent prenatal interventions to mitigate
Optimal Fat-modified Diet Duration for the Treatment of Postoperative Chylothorax in Children. Dietary modification is the mainstay of treatment for postoperative chylothorax in children. However, optimal fat-modified diet (FMD) duration to prevent recurrence is unknown. Our aim was to determine the association between FMD duration and chylothorax recurrence. Retrospective cohort study conducted across six pediatric cardiac intensive care units within the United States. Patients <18 years who developed chylothorax within 30 days following cardiac surgery between January 2020 and April 2022 were included. Patients with a Fontan palliation or who died or were lost to follow-up or within 30 days of resuming a regular diet were excluded. FMD duration was defined as the first day of a FMD when
Neonatal Chylothorax and Early Fluid Overload After Cardiac Surgery: Retrospective Analysis of the Neonatal and Pediatric Heart and Renal Outcomes Network Registry (2015-2018). To evaluate the association between postoperative cumulative fluid balance (FB) and development of chylothorax in neonates after cardiac surgery. Multicenter, retrospective cohort identified within the Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) Registry. Twenty-two hospitals were involved with NEPHRON, from September 2015 to January 2018. Neonates (< 30 d old) undergoing index cardiac operation with or without cardiopulmonary bypass (CPB) entered into the NEPHRON Registry. Postoperative chylothorax was defined in the Pediatric Cardiac Critical Care Consortium as lymphatic fluid in the pleural
Lymphoscintigraphy Findings are Associated with Outcome in Children with Chylothorax After Cardiac Surgery. Postoperative chylothorax in patients with congenital heart diseases (CHD) results in poor outcomes if anatomical and functional abnormalities of the lymphatic system are present. While these abnormalities are typically diagnosed by intranodal lymphangiography and dynamic contrast magnetic
Cough-induced chylothorax in a two-year-old boy - case report and review of the literature. Chylothorax is a very rare form of pleural effusion in children, especially after the neonatal period, and predominantly occurs secondary to cardiothoracic surgery. It can lead to significant respiratory distress, immunodeficiency, and malnutrition. Effective treatment strategies are therefore required to reduce morbidity. A previously healthy two-year old boy was admitted with history of heavy coughing followed by progressive dyspnea. The chest X-ray showed an extensive opacification of the right lung. Ultrasound studies revealed a large pleural effusion of the right hemithorax. Pleural fluid analysis delivered the unusual diagnosis of chylothorax, most likely induced by preceded excessive coughing
Thoracic duct embolization in treating postoperative chylothorax: does bail-out retrograde access improve outcomes? To evaluate clinical outcomes of thoracic duct embolization (TDE) for the management of postoperative chylothorax with the aid of the bail-out retrograde approach for thoracic duct cannulation (TDC). Forty-five patients with postoperative chylothorax underwent Lipiodol
Pragmatic role of noncontrast magnetic resonance lymphangiography in postoperative chylothorax or cervical chylous leakage as a diagnostic and preprocedural planning tool. To define the roles of noncontrast magnetic resonance lymphangiography (MRL) in the management of postoperative chylothorax or cervical chylous leakage. A total of 50 consecutive patients underwent noncontrast MRL, intranodal
Nontraumatic Chylothorax and Chylopericardium: Diagnosis and Treatment Using an Algorithmic Approach Based on Novel Lymphatic Imaging. Outcomes of interventional lymphangiographic treatment of nontraumatic chylous pleural effusions using traditional approaches have been highly variable. Recent advances in lymphatic imaging have revealed variations in underlying pathophysiology, enabling improved targeting of therapeutic interventions. To assess outcomes of an algorithm for management of nontraumatic chylous pleural effusions based on advanced magnetic resonance (MR) identification of various abnormalities in the thoracoabdominal lymphatic network that give rise to chylothorax. Novel lymphatic MR imaging was performed in 52 patients aged 11-89 years. Three distinct pathophysiological
Novel Subdiaphragmatic Ligation of Left Thoracic Duct for Refractory Postoperative Left Chylothorax. A postoperative chylothorax is an uncommon but problematic surgical complication in 0.5% to 4.0% of surgical cases that nevertheless still plagues every busy thoracic surgeon. Fortunately, most chylothoraces are low volume and are readily controlled by conservative measures. A high-volume chylothorax (>1 L/24 h) fortunately occurs in less than one-third of patients, usually responding to the published treatment algorithms and generally requiring invasive techniques. We report a case of a postlobectomy high-volume, left-sided chylothorax refractory to all the usual recommended interventions that ultimately was successfully treated by novel computed tomography lymphangiography-guided
Management of congenital and postoperative chylothorax: Use of thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography. Congenital chylothorax (CCT) and postoperative chylothorax (POCT) are rare and difficult to treat. We report our treatment strategy and outcomes for chylothorax, including thoracoscopic surgery with indocyanine-green (ICG) near-infrared fluorescence was 12/19 for CCT, 22/23 for CDH, and 4/7 for EA. Surgical intervention was performed in 10 patients, and the rate of resolution of chylothorax within 3 weeks after surgery was 90%. Thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography are feasible and useful in patients with chylothorax refractory to conservative treatment. Level IV.
Post-operative Chylothorax in Patients with Repaired Transposition of the Great Arteries. Patients with dextro-transposition of the great arteries (d-TGA) require surgical repair as neonates. These patients are at risk for post-operative chylothorax. We sought to describe the presentation, imaging, and outcomes after intervention for patients with d-TGA with post-operative chylothorax . A retrospective chart review was performed in patients with repaired d-TGA who were referred from 1/1/2013 to 4/1/2020 for evaluation of chylothorax. Patient history, lymphatic imaging, and interventional data were collected. Impact of intervention on lymphatic drainage was evaluated with a student's t-test. Eight patients met inclusion criteria for this study. Five patients had a history of central venous