Congenital chylothorax

Chylothorax is defined as the presence of lymph in the pleural space. Conge nital chylothorax is one of the most frequent causes of fetal pleural effus ion. It may be primary or secondary. Careful assessment of the etiology and of possible associated anomalies is required. Main complications are pulmo nary hypoplasia, hydrops fetalis and the risk of premature delivery. Manage ment is still a mater of controversy, the diagnosis of fetal pulmonary hypo plasia being difficult in utero. Factors such as gestational age, evolution of pleural effusion oil two weeks, signs of seriousness (hydrops fetalis), and pulmonary expansion after pleural puncture may help the physician to c hoose between abstention, pleural lapping or long-term in utero drainage. P ast natal treatment consists of pleural drainage and assisted ventilation i n cases of respiratory distress, correction of metabolic and immune disorde rs and exclusive parenteral nutrition. Once chylothorax is resolved, formul a feeding without long-chain triglycerides is allowed. If pleural effusion persists despite a well conducted treatment, albumin infusion and diuretics any be used before considering surgical treatment. (C) 1999 Elsevier, Pari s.