Etiology and management of pediatric chylothorax

Objectives: To determine the incidence and etiology of chylothorax and to a ssess our therapeutic management approach. Study design: We reviewed 51 patients diagnosed with chylothorax over a 12- year period. Cause, interval between operation and diagnosis, duration of c hylothorax, and total volume lass per weight were recorded. Results: Chylothorax was diagnosed in 46 children after cardiothoracic surg ery, giving an incidence of 2.5% (46/1842); in 1 child chylothorax occurred after chest trauma, and in 4 the chylothorax was congenital or a manifesta tion of lymph angiomatosis. Three etiologic groups were identified: group 1 , direct injury to the thoracic duct (33/51 = 65%); group 2, thrombosis and /or high venous pressure in the superior vena cava (14/51 = 27%); and group 3, congenital (4/51 = 8%). Conservative treatment was the only treatment i n 80% of the patients. Surgical procedures consisted of 4 ligations of the thoracic duct, placement of 7 pleurodesis shunts, and placement of 2 pleuro peritoneal shunts. Patients in groups 2 and 3 were at higher risk for failu re of conservative treatment (P < .005). Longer duration of chylothorax and higher volume of drainage were present in group 2 compared with group 1 (P < .01). Conclusion: Conservative treatment was successful in 80% of the patients wi th our management approach. Prevention, early recognition, and treatment of potential complications, such as superior vena cava thrombosis or obstruct ion, may further improve success of conservative treatment. Congenital chyl othorax seems different and may require a specific approach.