Study objective: To establish guidelines for the
diagnosis and management of chylothorax in children.
Design: Retrospective study.
Fifty-one patients with a diagnosis of chylothorax. Twelve
patients were excluded because of incomplete data or incorrect
diagnosis. The following parameters were analyzed: triglyceride level,
total cell number, and lymphocyte percentage; amount of pleural
effusion on day of diagnosis, day 5, and day 14; and total time of
pleural effusion. Prospectively, the same parameters were analyzed in a
control group of 10 patients with pleural drainage.
Intervention: Patients with chylothorax were treated
primarily with fat-free oral nutrition; if chyle did not stop, total
parenteral nutrition with total enteric rest was started. If
conservative therapy was not successful, pleurodesis was
Results: In children with chylothorax
triglyceride, triglyceride content ranged from 0.56 to 26.6
mmol/L; all values except one were > 1.1 mmol/L. In 36 of 39 patients
(92%), the cell count was > 1,000 cells/μL. In 33 of
39 patients (85%), lymphocytes were > 90%. In patients without
chylothorax triglyceride, triglyceride levels ranged from 0.1 to 0.71
mmol/L (median, 0.38 mmol/L) and cell count was from 20 to 1400
cells/μL (median, 322 cells/μL), with a maximum of 60%
lymphocytes. With fat-free nutrition, chyle disappeared in 29 of 39
patients. Five patients died, and five required pleurodesis.
Conclusions: Pleural effusion in children is chyle
when it contains > 1.1 mmol/L triglycerides (with oral fat intake)
and has a total cell count ≥ 1,000 cells/μL, with a lymphocyte
fraction > 80%. Chylous effusions usually last long; however,
after 6 weeks, the majority of the effusions (29 of 39 patients) had
ceased. Late surgical interventions reduce the number of thoracotomies
substantially, but can lead to very long hospitalization times. Early
surgical interventions (after < 3 weeks) lead to a high number of
thoracotomies, but certainly reduce hospitalization