CHYLOTHORAX: APPROACHES TO DIAGNOSIS AND TREATMENT
Main Article Content
Chylothorax is a rare disease and epidemiologically is most commonly found in children. It can also result in severe respiratory morbidity such as pleural effusion and has a high mortality rate in children. Conservative treatment and consideration of surgical intervention may be warranted as the primary goal of chylothorax management is to remove fluid accumulation in the pleural cavity, avoid recurrence, treat associated problems, and find the underlying cause while maintaining optimal nutrition. We report two cases of chylothorax in children. Data were collected retrospectively from children diagnosed with chylothorax in the pediatric ward of RSUD Dr. Soetomo in 2022. This is a series of cases that includes two children diagnosed with chylothorax. case series involving two patients who underwent cardiac and congenital thoracic surgery and developed chylothorax. Patients receiving partial parenteral nutrition with MCT have improved drainage outcomes. After birth, thoracentesis closes the thoracic drainage, and life support is usually necessary for babies with chylothorax because they often have poor cardiopulmonary function
Keywords:
chylothorax, chylous effusion, pleural effusion, children
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Attar, M. A., & Donn, S. M. (2017). Congenital chylothorax. Seminars in Fetal and Neonatal Medicine, 22(4), 234–239.
Bender, B., Murthy, V., & Chamberlain, R. S. (2016). The changing management of chylothorax in the modern era. European Journal of Cardio-Thoracic Surgery, 49(1), 18–24. https://doi.org/10.1093/ejcts/ezv041
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Healy, H., Gipson, K., Hay, S., Bates, S., & Kinane, T. B. (2017). A case series is a management and outcome of congenital chylothorax in the neonatal intensive care unit. Pediatric Investigation, 1(1), 21–25. https://doi.org/10.1155/2021/6634326
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Lee, C.-J., Tsao, P.-N., Chen, C.-Y., Hsieh, W.-S., Liou, J., & Chou, H.-C. (2016). Prenatal therapy improves the survival of premature infants with congenital chylothorax. Pediatrics & Neonatology, 57(2), 127–132.
Mery, C. M., Moffett, B. S., Khan, M. S., Zhang, W., Guzmán-Pruneda, F. A., Fraser Jr, C. D., & Cabrera, A. G. (2014). Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. The Journal of Thoracic and Cardiovascular Surgery, 147(2), 678–686. https://doi.org/10.1016/j.jtcvs.2013.09.068
Neumann, L., Springer, T., Nieschke, K., Kostelka, M., & Dähnert, I. (2020). ChyloBEST: Chylothorax in infants and nutrition with low-fat breast milk. Pediatric Cardiology, 41, 108–113.
Pulle, M. V., Puri, H. V., Asaf, B. Bin, Bishnoi, S., Yadav, A., & Kumar, A. (2021). Chylothorax-Modalities of management and outcomes: A case series. Lung India: Official Organ of Indian Chest Society, 38(2), 154. https://doi.org/10.4103/lungindia.lungindia_526_20
Rocha, G., Arnet, V., Soares, P., Gomes, A. C., Costa, S., Guerra, P., Casanova, J., & Azevedo, I. (2021). Chylothorax in the neonate—a stepwise approach algorithm. Pediatric Pulmonology, 56(10), 3093–3105.
Samanidis, G., Kourelis, G., Bounta, S., & Kanakis, M. (2022). Postoperative Chylothorax in Neonates and Infants after Congenital Heart Disease Surgery—Current Aspects in Diagnosis and Treatment. Nutrients, 14(9), 1803. https://doi.org/10.3390/nu14091803
Senarathne, U. D., Rodrigo, R., & Dayanath, B. K. T. P. (2021). Milky pleural effusion in a neonate and approach to investigating chylothorax. BMJ Case Reports, 14(9).
Tutor, J. D. (2014). Chylothorax in infants and children. Pediatrics, 133(4), 722–733. https://doi.org/10.1542/peds.2013-2072
White, M. K., Bhat, R., & Greenough, A. (2019). Neonatal chylothoraces: a 10-year experience in a tertiary neonatal referral center. Case Reports in Pediatrics, 2019.
Yee, K. C. K., Hern, O. T., Ching, N. Z., Pillai, N., Henry, A., & Chan, L. T. (2018). An Extraordinary Case of Idiopathic Chylothorax in a Rural Setting. Open Access Library Journal, 5(10), 1–7. https://doi.org/https://doi.org/10.4236/oalib.1104924
AICNU. (2015). Lekha V.S. Nutritional Management of Chylothorax. https://aicnu.org/wp-content/uploads/2015/01/Chylothorax.pdf .
Attar, M. A., & Donn, S. M. (2017). Congenital chylothorax. Seminars in Fetal and Neonatal Medicine, 22(4), 234–239.
Bender, B., Murthy, V., & Chamberlain, R. S. (2016). The changing management of chylothorax in the modern era. European Journal of Cardio-Thoracic Surgery, 49(1), 18–24. https://doi.org/10.1093/ejcts/ezv041
Bryant, A. S., Minnich, D. J., Wei, B., & Cerfolio, R. J. (2014). The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. The Annals of Thoracic Surgery, 98(1), 232–237. https://doi.org/10.1016/j.athoracsur.2014.03.003
Buckley, J. R., Graham, E. M., Gaies, M., Alten, J. A., Cooper, D. S., Costello, J. M., Domnina, Y., Klugman, D., Pasquali, S. K., & Donohue, J. E. (2017). Clinical epidemiology and center variation in chylothorax rates after cardiac surgery in children: a Pediatric Cardiac Critical Care Consortium report. Cardiology in the Young, 27(9), 1678–1685.
Chai, T., Lin, Y., Kang, M., & Lin, J. (2019). Thoracotomy versus video-assisted thoracoscopic lung cancer resection: A protocol for a systematic review and meta-analysis. Medicine, 98(10).
Dehghan, K. (2019). Idiopathic chylothorax in a term neonate and successful treatment with octreotide and medium chain triglyceride-enriched formula: a case report. International Journal of Pediatrics, 7(6), 9535–9540. https://doi.org/10.22038/ijp.2019.38710.3310
DiLauro, S., Russell, J., McCrindle, B. W., Tomlinson, C., Unger, S., & O'Connor, D. L. (2020). Growth of cardiac infants with post-surgical chylothorax can be supported using modified fat breast milk with proactive nutrient enrichment and advancement feeding protocols in an open-label trial. Clinical Nutrition ESPEN, pp. 38, 19–27. https://doi.org/10.22038/ijp.2019.38710.3310
Dori, L., Smaropoulos, E., Tagarakis, G., Foroulis, C. N., Zarogoulidis, P., Huang, H., Chong, B., Hohenforst-Schmidt, W., & Tsikopoulos, G. (2017). Successful treatment of familial congenital chylothorax by ligating the thoracic duct: A case report. Respiratory Medicine Case Reports, pp. 21, 66–68. https://doi.org/10.1016/j.rmcr.2017.03.017
Downie, L., Sasi, A., & Malhotra, A. (2014). Congenital chylothorax: associations and neonatal outcomes. Journal of Paediatrics and Child Health, 50(3), 234–238.
Healy, H., Gipson, K., Hay, S., Bates, S., & Kinane, T. B. (2017). A case series is a management and outcome of congenital chylothorax in the neonatal intensive care unit. Pediatric Investigation, 1(1), 21–25. https://doi.org/10.1155/2021/6634326
Hermon, M., Tenner, E., Burda, G., Strohmaier, W., Schlager, G., & Golej, J. (2019). Chylothorax and chylous-like diseases in children: clinical management. Frontiers in Pediatrics, 7, 258. https://doi.org/10.3389/fped.2019.00258
Justice, L., Buckley, J. R., Floh, A., Horsley, M., Alten, J., Anand, V., & Schwartz, S. M. (2018). Nutrition considerations in the pediatric cardiac intensive care unit patient. World Journal for Pediatric and Congenital Heart Surgery, 9(3), 333–343.
Kankananarachchi, I., Priyankara, K. K. S., Lakman, K. K. K., Withanaarachchi, K., & Gunathilaka, P. K. G. (2021). Two Cases of Congenital Chylethorax: A Successful Story of Medical Management. Case Reports in Pediatrics, 2021, 1–4. https://doi.org/10.1155/2021/6634326
Krishnamurthy, M. B., & Malhotra, A. (2017). Congenital chylothorax: current perspectives and trends. Research and Reports in Neonatology, pp. 53–63. https://doi.org/https:// doi.org/10.2147/RRN.S128703
Lee, C.-J., Tsao, P.-N., Chen, C.-Y., Hsieh, W.-S., Liou, J., & Chou, H.-C. (2016). Prenatal therapy improves the survival of premature infants with congenital chylothorax. Pediatrics & Neonatology, 57(2), 127–132.
Mery, C. M., Moffett, B. S., Khan, M. S., Zhang, W., Guzmán-Pruneda, F. A., Fraser Jr, C. D., & Cabrera, A. G. (2014). Incidence and treatment of chylothorax after cardiac surgery in children: analysis of a large multi-institution database. The Journal of Thoracic and Cardiovascular Surgery, 147(2), 678–686. https://doi.org/10.1016/j.jtcvs.2013.09.068
Neumann, L., Springer, T., Nieschke, K., Kostelka, M., & Dähnert, I. (2020). ChyloBEST: Chylothorax in infants and nutrition with low-fat breast milk. Pediatric Cardiology, 41, 108–113.
Pulle, M. V., Puri, H. V., Asaf, B. Bin, Bishnoi, S., Yadav, A., & Kumar, A. (2021). Chylothorax-Modalities of management and outcomes: A case series. Lung India: Official Organ of Indian Chest Society, 38(2), 154. https://doi.org/10.4103/lungindia.lungindia_526_20
Rocha, G., Arnet, V., Soares, P., Gomes, A. C., Costa, S., Guerra, P., Casanova, J., & Azevedo, I. (2021). Chylothorax in the neonate—a stepwise approach algorithm. Pediatric Pulmonology, 56(10), 3093–3105.
Samanidis, G., Kourelis, G., Bounta, S., & Kanakis, M. (2022). Postoperative Chylothorax in Neonates and Infants after Congenital Heart Disease Surgery—Current Aspects in Diagnosis and Treatment. Nutrients, 14(9), 1803. https://doi.org/10.3390/nu14091803
Senarathne, U. D., Rodrigo, R., & Dayanath, B. K. T. P. (2021). Milky pleural effusion in a neonate and approach to investigating chylothorax. BMJ Case Reports, 14(9).
Tutor, J. D. (2014). Chylothorax in infants and children. Pediatrics, 133(4), 722–733. https://doi.org/10.1542/peds.2013-2072
White, M. K., Bhat, R., & Greenough, A. (2019). Neonatal chylothoraces: a 10-year experience in a tertiary neonatal referral center. Case Reports in Pediatrics, 2019.
Yee, K. C. K., Hern, O. T., Ching, N. Z., Pillai, N., Henry, A., & Chan, L. T. (2018). An Extraordinary Case of Idiopathic Chylothorax in a Rural Setting. Open Access Library Journal, 5(10), 1–7. https://doi.org/https://doi.org/10.4236/oalib.1104924
