Chylothorax

The chylothorax is an accumulation of lymphatic fluid ( gr = Chylos, milk juice ') in the pleural cavity. This is usually done by a violation of the so-called breast duct ( thoracic duct ). This leads a day for up to four liters of lymph from a large part of the body back into the venous blood. With injuries this lymph ( Chylorrhö ) runs into adjacent structures. Apart from the chest cavity, the lymph especially in severe trauma also in the pericardium ( the so-called Chyloperikard ) run and lead to cardiac tamponade. If the lymph to the mediastinal area ( mediastinum ) limited, so it is called a Chylomediastinum.

Causes

• Spontaneous rupture
• Intraoperative injury ( Va after operations on the esophagus, the heart and the aorta)
• Acute and obtuse trauma
• Relocation of the thoracic duct (eg caused by a tumor )
• Gorham - Stout syndrome

Symptoms

From a volume of about two liters, it usually comes by displacement of the lung and mediastinum to dyspnea and tachycardia.

Diagnostics

• Clinically weakening of the respiratory sound in the basal lung sections and in the percussion damping.
• X-ray: Radiographs of the chest can be seen shadows in the low-lying portions of the pleural cavity.
• Puncture: The puncture fluid is usually milky and sterile. Laboratory tests can be found in an increased fat content.

Therapy

By repeatedly releasing the chylothorax (eg via a Bülau drainage) one first tries sticking the injured site of the thoracic duct to be seen. This can be supported by a special diet (MCT diet with medium-chain fats), in which the transported via the lymphatics short-and long-chain fats are avoided in the diet. Occurs after 1-2 weeks there is no improvement, the site of injury surgically as a rule, and the thoracic duct produced by direct suture again, or perform a pleurodesis in cases of unclear etiology.

• Disease in orthopedic and trauma surgery
• Disease in thoracic surgery