Abstract
Background
Utilization of tunneled indwelling pleural catheters (TIPCs) for persistent pleural
effusions is increasingly more common; however, the presence of chylothorax is generally
considered a contraindication for utilization of a TIPC due to concerns regarding
potential nutritional, immunologic and hemodynamic complications. Therefore, in this
study, a cohort of patients with persistent benign chylothorax managed with TIPCs
is described.
Methods
A retrospective analysis of patients with persistent benign chylothorax managed with
a TIPC at the study center between January 1, 2008, and March 1, 2012, was completed.
Extracted data included patient characteristics, chylothorax etiologies, prior interventions,
outcomes and complications.
Results
Eleven patients (14 hemithoraces) had persistent benign chylothorax treated with placement
of a TIPC during the inclusion time frame. Etiology of the chylothorax was nontraumatic
in 8 of the 11 patients, with the remaining 3 secondary to thoracic surgery. Pleurodesis
was achieved in 9 of the 14 hemithoraces, with a median time to pleurodesis of 176
days. All procedures were well tolerated, and no immediate periprocedural complications
were reported. One serious complication was encountered in the form of a postoperative
pulmonary embolism after replacement of an occluded TIPC, resulting in the patient’s
death. Two patients had transient occlusions of their TIPCs successfully treated with
intracatheter thrombolytic therapy. No significant adverse nutritional, hemodynamic
or immunologic outcomes were reported during follow-up for any included patient.
Conclusions
Utilization of a TIPC for the management of persistent benign chylothorax should be
considered early because pleurodesis may be frequently and safely achieved in this
patient population.
Key Indexing Terms
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of the Medical SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Pleural fluid characteristics of chylothorax.Mayo Clin Proc. 2009; 84: 129-133
- The lipoprotein profile of chylous and nonchylous pleural effusions.Mayo Clin Proc. 1980; 55: 700-704
- Etiology of chylothorax in 203 patients.Mayo Clinic Proc. 2005; 80: 867-870
- The management of chylothorax.Chest. 1992; 102: 586-591
- Clinical and immunological alterations observed in patients undergoing long-term thoracic duct drainage.Surgery. 1978; 84: 157-165
- Use of an indwelling pleural catheter for the management of recurrent chylothorax in patients with cancer.Chest. 2007; 132: 1584-1590
- A review of the nutritional management of chyle leakage in adults.J Hum Nutr Diet. 1998; 11: 105-114
- Management of spontaneous congenital chylothorax: oral medium-chain triglycerides versus total parenteral nutrition.Am J Perinatol. 1999; 16: 415-420
- Treatment of chyluria and chylothorax with medium-chain triglyceride.N Engl J Med. 1964; 270: 756-761
- Dietary modification of chyle composition in chylothorax.Gastroenterology. 1989; 97: 761-765
- Lymphangiography in the diagnosis and localization of various chyle leaks.Cardiovasc Intervent Radiol. 2012; 35: 117-126
- Percutaneous treatment of thoracic duct injuries.Surg Endosc. 2011; 25: 2844-2848
- Chylothorax: aetiology, diagnosis and therapeutic options.Respir Med. 2010; 104: 1-8
- Medical and surgical management of chylothorax and associated outcomes.Am J Med Sci. 2010; 339: 314-318
- Use of LeVeen pleuroperitoneal shunt for refractory high-volume chylothorax.Ann Thorac Surg. 2004; 78: e9-e12
- Pleuro-peritoneal shunting.Alternative therapy for pleural effusions. Ann Surg. 1988; 208: 443-450
- Octreotide for the treatment of chylothorax in neonates.Cochrane Database Syst Rev. 2010; 9: CD006388
- Octreotide therapy for chylothorax in infants and children: a brief review.Pediatr Crit Care Med. 2006; 7: 576-579
- Octreotide and chylothorax.Curr Opin Pulm Med. 2006; 12: 264-267
Article info
Publication history
Accepted:
September 7,
2012
Received:
June 12,
2012
Footnotes
Supported by the Mayo Clinic Foundation and the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
The authors have no financial or other conflicts of interest to disclose.
Identification
Copyright
© 2013 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
