The thoracic duct is the body's main lymphatic drainage system. While this duct transports liquids and digested fats into the systemic circulation, it also returns proteins to the bloodstream outside the vascular system. Chylothorax is caused by a stoppage, blockage, or dysfunction in the passage of chylous fluid in the thoracic duct. Chylothorax is a life-threatening condition that must be treated. As a result, surgical therapy options have been targeted in conjunction with the aetiology and diagnosis of the disease. It can be caused by both non-traumatic and traumatic events (iatrogenic, blunt trauma or penetrating injury). The most common causes of chylothorax are traumatic 50%, non-traumatic 44%, and idiopathic 6%. Traumatic chylothorax causes medical and surgical interventions to the lungs, trachea, mediastinum, cardiovascular, aorta, neck, oesophagus, diaphragm, stomach, and vertebral bodies. The most prevalent causes of surgical traumatic chylothorax are esophagectomy and surgical therapies for congenital heart disease. Non-surgical traumatic chylothorax can be caused by increased intra-thoracic or intraabdominal pressure, violent trauma, giving birth, straining, sneezing, vomiting, seat belts, and thoracolumbosacral orthosis. Chest radiography does not reveal the cause of chylothorax in great detail. Thorax CT can reveal trauma regions in the lymphatic system, mediastinal lymph nodes, and tumoral lesions. The use of thoracentesis to acquire pleural fluid analysis is critical in the diagnosis of chylothorax. This fluid is 99 percent chylous if the triglyceride level in the pleural fluid is greater than 110 mg/dL. The most significant requirement is that the cholesterol/triglyceride ratio in the pleural fluid is less than 1. The placement of tube thoracostomy is usually the first step in surgical treatment for chylothorax. To re-dilate the lung and take advantage of compression effects, drainage is virtually always performed. If conservative therapy fail to work, surgical treatment is initiated. Drainage by tube thoracostomy, pleurodesis, duct ligation via video-assisted thoracoscopic surgery or thoracotomy, transabdominal thoracic duct mass ligation, and intraabdominal cisterna chyli ligation are all surgical methods. The loss of the lymphatic system is the most serious health issue in chylothorax sufferers. Electrolyte, lipid, protein, vitamin, and fluid losses should be restored during the course and treatment of the disease. In patients receiving long-term therapy, there is a substantial risk of immunodeficiency and malnutrition due to the loss of T cells in the lymphatic fluid. Malnutrition, infection, and immunodeficiency are the leading causes of death in chylothorax, so it should be treated right away.
Author(S) Details
Onur Bayrakci
Thoracic Surgery Department, Ersin Arslan Training and Research Hospital, Gaziantep, Turkey.
View Book:- https://stm.bookpi.org/RDMMR-V11/article/view/4646
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