Сhylothorax
Authors: Opanasenko M.S. , Konik B.M. , Belokon S.M. , Tereshkovych O.V. , Levanda L.I. , Shalagay S.M. , Kalenychenko M.I. , Shamray M.Yu. , Lysenko V.I. 
Published: July 2021

Objective — to determine and analyze, on our own experience, effective methods of treating chylothorax.

Materials and methods. For the last 15 years on the basis of the department of surgical treatment of tuberculosis and invasive diagnostic methods of the SI «National Institute of Phthisiology and Pulmono­logy named after F.G. Yanovsky NAMS of Ukraine» was treated 21 patients with a diagnosis of chylothorax. Among the concomitant pathologies, the following diseases were most often diagnosed: ischemic heart disease 5 (23.8 %) cases, gynecological diseases 7 (32.9 %), obesity 4 (18.8 %).

Results and discussion. An analysis was perfomed, which allows us to conclude that most often (10 cases, 47.6 %) chylothorax was diagnosed in women as a manifestation of lymphangioleiomyomatosis (LAM). It should be noted that in 4 (36.3 %) patients, LAM was diagnosed only by lung biopsy. In 2 (18.1 %) women, chylothorax was bilateral. In 6 (54.5 %) cases, a history of spontaneous pneumothorax (a characteristic diagnostic sign of LAM). The second place among the causes of chylothorax was by intrathoracic lymph node dissection during surgery for lung cancer. In all 3 (14.2 %) cases, the patients underwent left­sided pulmonectomy. Chylothorax usually developed by about 5—7 days, which coincided with the mobilization of patients and the restoration of adequate nutrition. In 2 (9.5 %) patients, the cause of chylothorax was damage to the thoracic duct during neurosurgical intervention through the transpleural approach. Such chylothorax is characterized by an aggressive course, quickly leads to exhaustion of the patient and requires immediate surgical intervention to ligate the thoracic duct below the level of injury. In 2 (9.5 %) patients, chylothorax was one of the manifestations of idiopathic pulmonary ossification. It should be noted that the diagnosis of pulmonary ossification was established only after a histological examination of a biopsy specimen, while such patients were admitted to the clinic with a diagnosis of recurrent pleurisy. In both cases, it was possible to achieve cessation of lymphorrhea by using parietal pleurectomy and conservative therapy. A feature of these patients is the fact that even with the elimination of chylothorax, moderate manifestations of respiratory failure remained in them. Chylothorax in lymphoproliferative diseases — in 2 cases (9.5 %) was the result of the prevalence of the oncological process, and therefore after its diagnosis, only pleural punctures and symptomatic treatment were performed. In no case was it possible to achieve complete cessation of lymphorrhea. In 1 (4.7 %) patient, idiopathic right­sided recurrent chylothorax was observed with moderate hilar lymphadenopathy. Videothoracoscopic biopsy of the intrathoracic lymph nodes was supplemented with parietal pleurectomy. This made it possible to achieve a reliable cessation of lymphorrhea, however, according to the data of a histopathological study, only reactive nonspecific changes were presented in the lymph nodes. In another 1 (4.7 %) case, on the 4th day after right­sided parietal pleurectomy for chronic pleural tuberculosis, lymphorrhea developed on the side of the operation. Short­term conservative therapy made it possible to achieve a positive result.Thus, the overall effectiveness of the treatment of such a pathological condition as chylothorax was 85.7 %.

Conclusions. Chylothorax is a complex medical problem, the effective solution of which depends on a complex of conservative and surgical methods of treatment.The most common cause of chylothorax is lymphangioleiomyomatosis (47.6 %). The overall effectiveness of chylothorax treatment in the clinic is 85.7 %.