Pediatr Allergy Respir Dis.  2001 Dec;11(4):335-344.

Spontaneous Chylothorax in Children

Affiliations
  • 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Pediatrics, Wonkwang University School of Medicine, Kunpo Medical Center, Kunpo, Korea.

Abstract

PURPOSE
The purpose of this study was to review the cases of spontaneous chylothorax and its diagnosis, treatment, outcome, and complications.
METHODS
We retrospectively reviewed the medical records of 10 patients who were diagnosed as spontaneous chylothorax in Seoul National University Children's Hospital between January 1990 and August 2001. We reviewed demographic data, pleural fluid analysis, treatment modalities, complications, and outcomes.
RESULTS
Spontaneous chylothorax was identified in 10 patients including 5 infants with congenital origin. Chylothorax was noted in left(3 cases), right(2 cases) and bilatelly in five cases. Three of five infants with congenital chylothorax were born with hydrops fetalis and two were born prematurely. Pleural fluid laboratory findings were as follows: WBC>1,000/microliter, lymphocytes 92.8+/-9.9%, protein 3.9+/-2.7 g/dL, triglyceride 994+/-825 mg/dL, cholesterol 46.6+/-26.7 mg/dL. All cases were treated initially with a combination of repeated thoracenteses and/or pleural drains, total parenteral nutrition, medium-chain triglyceride based formula or low fat diet. Seven cases responded to conservative treatment. One infant underwent successful thoracic duct ligation. Chylothorax persisted in 2 cases. There was an initial response to steroid treatment in 1 infant who was considered Noonan syndrome, but chylous effusion increased during the tapering of steroid.
CONCLUSION
Conservative treatment was successful in 70% of the patients. A precise diagnosis, proper treatment, and prevention and treatment of complications are important in the management of chylothorax. Familiarity with the therapeutic options and appropriate timing for surgical intervention will be required.

Keyword

Spontaneous chylothorax; Congenital chylothorax; Medium-chain triglyceride

MeSH Terms

Child*
Cholesterol
Chylothorax*
Diagnosis
Diet
Humans
Hydrops Fetalis
Infant
Ligation
Lymphocytes
Medical Records
Noonan Syndrome
Parenteral Nutrition, Total
Recognition (Psychology)
Retrospective Studies
Seoul
Thoracic Duct
Triglycerides
Cholesterol
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