What is Chylothorax?
The lymphatic system plays a key role in helping to maintain fluid levels in our tissues, fat and protein transport, and optimising the function of our immune system through the transport of inflammatory cells throughout the body.
The lymphatic system filters and drains lymph fluid from all over the body, including through our chest and thoracic cavity. When the lymphatic system is blocked, or if a part of it leaks, the normal flow of lymph fluid is obstructed. This can result in leakage of lymph fluid or a collection of lymph fluid within the body cavity.
Chylothorax, also known as a chylous effusion, is a rare condition where lymphatic fluid, or chyle, collects in the thin spaces around the lungs (the pleural space). Chylothorax can occur in one lung or both lungs and is caused by an abnormal circulation of lymphatic fluid. When there is a little fluid within the pleural space, symptoms may not be present. However, as the fluid builds up, chylothorax can result in symptoms such as:
- Shortness of breath
- Chest pain
- Chest discomfort
What is the most common cause of Chylothorax?
Chylothorax occurs when there is a disruption to the normal flow of lymph through the lymphatic vessels, resulting in leakage of chyle out of the vessels and into the pleural space. There are many causes of chylothorax, including:
- Injury to the thoracic duct (the main lymph vessel in the chest) due to surgery or trauma [traumatic chylothorax is the most common cause of chylothorax]
- Lung cancer
- Congenital abnormalities that result in the abnormal flow of lymph, such as lymphangiomatosis or Turner syndrome
- Conditions that result in high pressures within the veins, such as heart failure and pulmonary hypertension
Is Chylothorax life-threatening?
Chylothorax is a serious and potentially fatal disease if not treated in time. This is because chylothorax can lead to sequelae such as respiratory distress when a significant amount of fluid accumulates in the lungs as the flow of air and oxygen in the lungs gets obstructed by the lymph fluid. This can lead to rapid deterioration and can be fatal, especially in the case of traumatic chylothorax, where there is an injury to the main lymph vessels.
Other complications of chylothorax include malnutrition, immunosuppression, and dehydration. The rates at which these complications develop depends on how quickly the chylothorax accumulates, its size, and how long the chylothorax has been in the lungs.
How do you treat Chylothorax?
Chylothorax treatment in Singapore depends on the underlying cause. Here at ICTS, the management of chylothorax is divided into 3 primary phases:
Treating the underlying cause
The mainstay of initial management would be to treat the underlying cause of chylothorax to prevent further management. This includes management of the primary medical condition such as heart failure and ensuring good cancer control in lung cancer patients who have developed chylothorax as a result of the tumour growth.
Medical management of a chylothorax includes putting a drain in the chest to drain fluid from the pleural space. Another treatment option involves medications administered directly into the bloodstream.
Patients usually need to be fasted before carrying out an intercostal chest drain. This helps to decompress the lungs and reduce pressure within the pleural space, thereby helping to restore lung function. Patients with large chylothoraces may also require some nutritional support as chylothorax can lead to a loss of proteins and electrolytes within the body.
At ICTS, there are several procedures that can be done for chylothorax. These include robotic surgery, video-assisted surgery, and open thoracic surgery. Surgery is done to repair any damage to the thoracic duct and to seal the defect.
Surgery is often indicated in cases such as post-traumatic chylothorax and cases of chylothorax which do not respond to other treatments. Sometimes, a shunt may also be done in rare cases to allow the drainage of fluid to other parts of the body.
Can Chylothorax go away?
Chylothorax can be cured, and the long-term outlook, with proper management, is good. Treatment of the underlying cause of chylothorax can help provide a cure to patients.
How long can you live with Chylothorax?
You can live with a chylothorax, although the risks of complications are high, and if there is no treatment, the chylothorax can progress and result in a condition that is potentially life-threatening. As such, it is important to seek early management of chylothorax and to treat its underlying cause.
If you experience any of the aforementioned symptoms, please visit your thoracic surgeon for a proper diagnosis and a personalised treatment plan.
Adams, Sasha D., and BS Anand. “Chylothorax: Background, Etiopathophysiology.” Medscape Reference, 20 November 2020, https://emedicine.medscape.com/article/172527-overview. Accessed 5 September 2022.
“Chylothorax – StatPearls.” NCBI, 24 January 2022, https://www.ncbi.nlm.nih.gov/books/NBK459206/. Accessed 5 September 2022.