SpringerLink
Log in

Chylothorax

  • Chapter
  • First Online:
Thoraxchirurgie

Part of the book series: Springer Reference Medizin ((SRM))

  • 1127 Accesses

Zusammenfassung

Der Chylothorax ist ein seltenes Krankheitsbild, welches unbehandelt lebensbedrohlich werden kann. Es gibt traumatische und nichttraumatische Ursachen, wobei die häufigste traumatische Ursache eine vorausgegangene Operation und die häufigste nichttraumatische Ursache eine Neoplasie ist. Der Chylusverlust pro Tag entscheidet über die Indikation für ein konservatives oder operatives Vorgehen. Bei einem Nachweis von Chylomikronen und Triglyzeriden von ≥110 mg/dl im Pleurapunktat ist die Diagnose eines Chylothorax gesichert. Flüssigkeits-, Eiweiß- und Lipidverluste müssen rechtzeitig substituiert werden. Zur intraoperativen Detektion von Leckagen des Ductus thoracicus ist die Gabe von Sahne über die Magensonde Mittel der Wahl. Unabhängig von der Genese und erfolgreichen Behandlung des Chylothorax sollte zur Rezidivprophylaxe die Diätkost mit mittelkettigen Triglyzeriden (MCT-Kost) für mindestens 1 Woche fortgeführt werden.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
EUR 29.95
Price includes VAT (Germany)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
EUR 289.00
Price includes VAT (Germany)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
EUR 299.99
Price includes VAT (Germany)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Literatur

  • Agrawal V, Sahn SA (2008) Lipid pleural effusions. Am J Med Sci 335(1):16–20

    Article  PubMed  Google Scholar 

  • Almoosa KF, McCormack FX, Sahn SA (2006) Pleural disease in lymphangioleiomyomatosis. Clin Chest Med 27(2):355–368

    Article  PubMed  Google Scholar 

  • Al-Tawil K, Ahmed G, Al-Hathal M, Al-Jaraliah Y, Campbell N (2000) Congenital chylothorax. Am J Perinatol 17:121–126

    Article  CAS  PubMed  Google Scholar 

  • Baktas H, Bülbül Y, Özsu S, Özlü T (2015) A rare cause of chylothorax: Hennekam syndrome. Turk Thorac J 16(1):33–35

    Article  Google Scholar 

  • Bessone LN, Ferguson TB, Burford TH (1971) Chylothorax: a collective review. Ann Thorac Surg 12:527

    Article  CAS  PubMed  Google Scholar 

  • Boffa DJ, Sands MJ, Rice TW, Murthy SC, Mason DP, Geisinger MA, Blackstone EH (2008) A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery. Eur J Cardiothorac Surg 33:435–439

    Article  PubMed  Google Scholar 

  • Bolger C, Walsh TN, Tanner WA, Keeling P, Hennessy TP (1991) Chylothorax after oesophagectomy. Br J Surg 78(5):587–588

    Article  CAS  PubMed  Google Scholar 

  • Bölükbas S, Kudelin N, Dönges T, Schirren J (2009) Therapiemanagement des Chylothorax. Chirurg 81:255–265

    Article  Google Scholar 

  • Bryant AS, Minnich DJ, Wei B, Cerfolio RJ (2014) The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg 98:232–237

    Article  PubMed  Google Scholar 

  • Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC (1996) Postoperative chylothorax. J Thorac Cardiovasc Surg 112(5):1361–1365

    Article  CAS  PubMed  Google Scholar 

  • Cherian S, Umerah OM, Tufail M, Panchal RK (2019) Chylothorax in a patient with HIV-related Kaposi’s sarcoma. BMJ Case Rep 12(1):e227641

    Article  PubMed  PubMed Central  Google Scholar 

  • Dajee H, Woodhouse R (1994) Lymphangiomatosis of the mediastinum with chylothorax and chylopericardium: role of radiation treatment. J Thorac Cardiovasc Surg 108:594–595

    Article  CAS  PubMed  Google Scholar 

  • Downie L, Sasi A, Malhotra A (2013) Congenital chylothorax: associations and neonatal outcomes. J Paediatr Child Health 50(3):234–238

    Article  PubMed  Google Scholar 

  • Fujita T, Daiko H (2014) Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy. World J Surg 38:2039–2045

    Article  PubMed  Google Scholar 

  • Hamdan MA, Gaeta ML (2004) Octreotide and low-fat breast milk in postoperative chylothorax. Ann Thorac Surg 77:2215–2217

    Article  PubMed  Google Scholar 

  • Herberer G, Schildberg FW, Sunder-Plassmann L, Vogt-Moykopf I (Hrsg) (1991) Lunge und Mediastinum. Die Praxis der Chirurgie. Springer, Berlin/Heidelberg

    Google Scholar 

  • Huggins JT (2010) Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med 31(6):743–750

    Article  PubMed  Google Scholar 

  • Johnson D, Klazynski P, Gordon W, Russell D (1986) Mediastinal lymphangioma and chylothorax: the role of radiotherapy. Ann Thorac Surg 41:325–328

    Article  CAS  PubMed  Google Scholar 

  • Kariya S, Nakatani M, Ueno Y, Yoshida A, Ono Y, Maruyama T, Komemushi A, Tanigawa N (2018) Transvenous retrograde thoracic ductography: initial experience with 13 consecutive cases. Cardiovasc Intervent Radiol 41(3):406–414

    Article  PubMed  Google Scholar 

  • Kloth C, Cammerer G, Schmidt S (2019) Gezielte Magnetresonanztomografie zur exakten Leckage-Detektion beim Chylothorax. Rofo 191(1):62–64

    Article  PubMed  Google Scholar 

  • Langford RJ, Daudia AT, Malins TJ (1999) A morphological study of the thoracic duct at the jugulo-subclavian junction. J Craniomaxillofac Surg 27:100–104

    Article  CAS  PubMed  Google Scholar 

  • Lyng CS, Vegsundvåg J, Wahba A, Grenne B (2018) Constrictive pericarditis as a rare cause of chylothorax: a case report. Eur Heart J Case Rep 2:1–6

    Google Scholar 

  • Maldonado F, Tazelaar HD, Wang CW, Ryu JH (2008) Yellow nail syndrome. Chest 134(2):375–381

    Article  PubMed  Google Scholar 

  • Nair SK, Petko M, Hayward MP (2007) Aetiology and management of chylothorax in adullts. Eur J Cardiothorac Surg 32(2):362–369

    Article  PubMed  Google Scholar 

  • Nakabayashi H, Sagara H, Usukura N, Yoshimitsu K, Imamura T, Seta T, Yanase E, Kawato M, Hiraiwa Y, Sakato S, Takeda R (1981) Effect of somatostatin on the flow rate and triglyceride levels of thoracic duct lymph in normal and vagotomized dogs. Diabetes 30:440–445

    Article  CAS  PubMed  Google Scholar 

  • Paget-Brown A, Kattwinkel J, Rodgers BM, Michalsky MP (2006) The use of octreotide to treat congenital chylothorax. J Pediatr Surg 41:845–847

    Article  PubMed  Google Scholar 

  • Sachs PB, Zelch MG, Rice TW, Geisinger MA, Risius B, Lammert GK (1991) Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT. AJR Am J Roentgenol 157:703–705

    Article  CAS  PubMed  Google Scholar 

  • Seeliger B, Alesina PF, Walz MK (2018) Posterior retroperitoneoscopic thoracic duct ligation: a novel surgical approach. Surg Endosc 32(8):3732–3737

    Article  CAS  PubMed  Google Scholar 

  • Selle JG, Snyder WH, Schreiber JT (1973) Chylothorax: indications for surgery. Ann Surg 177(2):245–249

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shimada K, Sato I (1997) Morphological and histological analysis of the thoracic duct at the jugulo-subclavian junction in Japanese cadavers. Clin Anat 10:163–172

    Article  CAS  PubMed  Google Scholar 

  • Singh R, Krishnan S, George NA, Gowri BP, Iqbai Ahamed M, Sebastian P (2016) Bilateral chylothorax following neck dissection: case report & review of literature. Indian J Surg Oncol 7(1):115–118

    Article  PubMed  Google Scholar 

  • Siu SL, Yang JY, Hui JP, Li RC, Cheng VY, Cheung TW, Kwong AN (2012) Chylothorax secondary to catheter related thrombosis successfully treated with heparin. J Paediatr Child Health 48(3):105–107

    Article  Google Scholar 

  • Skandalakis J, Skandalakis L, Skandalakis P (2007) Anatomy of the lymphatics. Surg Oncol Clin North Am 16:1–16

    Article  Google Scholar 

  • Squitieri RP, DiMeo AC (2013) Left-sided robotic thoracic duct clip** for chylothorax. J Thorac Cardiovasc Surg 145(1):299–300

    Article  PubMed  Google Scholar 

  • Tie MLH, Poland GA, Rosenow EC (1994) Chylothorax in Gorham’s syndrome. Chest 105(1):208–213

    Article  CAS  PubMed  Google Scholar 

  • Toliyat M, Singh K, Simbley RC, Chamarthy M, Kalva SP, Pillai AK (2017) Interventional radiology in the management of thoracic duct injuries: anatomy, techniques and results. Clin Imaging 42:183–192

    Article  PubMed  Google Scholar 

  • Wasmuth-Pietzuch A, Hansmann M, Bartmann P, Heep A (2004) Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr 93:220–224

    Article  CAS  PubMed  Google Scholar 

  • Wurnig PN, Hollaus PH, Ohtsuka T, Flege JB, Wolf RK (2000) Thoracoscopic direct clip** of the thoracic duct for chylopericardium and chylothorax. Ann Thorac Surg 70:1662–1665

    Article  CAS  PubMed  Google Scholar 

  • Yannes M, Shin D, McCluskey K, Varma R, Santos E (2017) Comparative analysis of intranodal lymphangiography with percutaneous intervention for postsurgical chylous effusions. J Vasc Interv Radiol 28(5):704–711

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Thoraxchirurgie, Evang. Kliniken Essen-Mitte gGmbH, Essen, Deutschland

    Natalie Baldes

  2. Klinik für Thoraxchirurgie, Ruhrlandklinik, Essen, Deutschland

    Servet Bölükbas

Authors
  1. Natalie Baldes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Servet Bölükbas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Servet Bölükbas .

Editor information

Editors and Affiliations

  1. Sektion Thoraxchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    Hans Hoffmann

  2. Klinik für Thoraxchirurgie, Florence-Nightingale-Krankenhaus, Düsseldorf, Deutschland

    Corinna Ludwig

  3. Klinik für Thoraxchirurgie Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland

    Bernward Passlick

Section Editor information

  1. Freiburg, Germany

    Bernward Passlick

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Baldes, N., Bölükbas, S. (2023). Chylothorax. In: Hoffmann, H., Ludwig, C., Passlick, B. (eds) Thoraxchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59146-8_50

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-59146-8_50

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-59145-1

  • Online ISBN: 978-3-662-59146-8

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation