Allergy Asthma Respir Dis.  2019 Oct;7(4):206-211. 10.4168/aard.2019.7.4.206.

Clinical characteristics of nontraumatic chylothorax in pediatric patients

• Shin SH
• Song JH
• Kim MJ
• Hur S
• Kim WS
• Suh DI

• KMID: 2461398
• DOI: http://doi.org/10.4168/aard.2019.7.4.206

Abstract

PURPOSE
To evaluate clinical characteristics of pediatric nontraumaitc chylothorax and to suggest appropriate therapeutic managements.
METHODS
We retrospectively reviewed medical records of 22 patients with nontraumatic chylothorax from January 2005 to December 2018 in the Children's Hospital of Seoul National University. We analyze their etiology, treatment, complications and outcome.
RESULTS
Of the 22 patients, 16 were diagnosed before 1 year old and 6 after 1 year old. The causes of chylothorax under 1-year-old children were related to congenital factors (n=9), unknown causes (n=5), and high central venous pressure (n=2). The causes of chylothorax over 1-year-old children were related to congenital factors (n=3), unknown causes (n=1), high venous pressure (n=1), and lymphoma (n=1). All patients had dietary modification. Eight of them were cured by dietary modification, but there was no improvement in over 1-year-old children. Medication was added to patients refractory to dietary modification. Four patients with medication were improved and 5 were improved by surgical management. Nutritional, immunological and other complications occurred in many patients. Five death cases were reported. Four patients were under 1 year old and 1 was over 1 year old. The causes of nontraumatic chylothorax in dead patients were high central venous pressure (n=3), congenital (n=1), and unknown (n=1).
CONCLUSION
Nontraumatic chylothorax more frequently occurs in under 1-year-old children. The most common cause is congenital factors. Stepwise management is effective in many patients, but specific treatment is needed in some cases. The prognosis is related to the onset of age and underlying diseases.

Keyword

Nontraumatic chylothorax; Pediatrics; Diet; Management

MeSH Terms

Central Venous Pressure
Child
Chylothorax*
Diet
Food Habits
Humans
Lymphoma
Medical Records
Pediatrics
Prognosis
Retrospective Studies
Seoul
Venous Pressure

Figure

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  Fig. 1. Flow chart of the patient selection.

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  Fig. 2. (A) Lymphangiography that showed lymphatic leakage to thorax cavity. (B) Magnetic resonance lymphangiography before (left) and after (right) administration of sirolimus.

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