CHYLOTHORAX AND PSEUDOCHYLOTHORAX

Chylothorax is the occurrence of chylus (lymph) in the pleura due to d amage to the thoracic duct. There is a high content of triglycerides, and chylomicrons can be seen. It is usually right-sided, since most of the duct is within the right hemithorax. With damage at the level of the aorta, the chyle will appear on the left. Traumatic rupture occurs after accidents or surgery. Of nontraumatic causes, the most common i s a malignant lymphoma. Computed tomography (CT) scan of the thorax an d upper abdomen should be performed. Lymphography can show where the L eakage or blockage is situated With repeated drains, large amounts of fat, proteins, and lymphocytes are lost. Treatment is with low-fat die t or parenteral nutrition to decrease the amount of chyle, but chemica l pleurodesis or ligation of the thoracic duct, usually via thoracosco py, is often necessary, Pseudochylothorax (cholesterol pleurisy) occur s with long-standing fluid in a fibrotic pleura The fluid has a high c ontent of cholesterol but no triglycerides or chylomicrons. In both co nditions, the pleural fluid is thick, opalescent, whitish or the colou r of cafe-au-lait.