Chylothorax arises when there is an accumulation of lymph between the layers that line the lungs, called pleurae. Lymph usually accumulates in this region due to a lesion in the lymphatic vessels of the chest, which can happen due to causes such as trauma, tumor, infection or due to a congenital change in the anatomy of the newborn.
Chylothorax can cause signs and symptoms such as shortness of breath, chest pain or cough, and the treatment is done by the pulmonologist or thoracic surgeon, which may include fasting or using medications to decrease the production of fluid in the lymphatic vessels, in addition to drainage. of the region's liquid and surgery to correct its cause.
The accumulation of any substance between the pleura is called a pleural effusion, and the chylothorax is the least common type of this problem, which can also happen due to the accumulation of fluids, blood, pus or air, for example. Understand better what a pleural effusion is and how it happens.
What are the causes
Generally, a chylothorax arises due to obstruction or difficulty in the flow of lymph in the lymphatic vessels, as well as lesions in these vessels or congenital malformations of its anatomy. The main causes include:
- Trauma to the chest, due to accidents, falls, injuries by weapons or surgery; Congenital causes, such as atresia of the thoracic duct, congenital thoracic duct fistula, deformities in the lymphatic vessels or even a blow during the delivery of the baby; Benign or malignant tumors. Check out how to identify lymphatic cancer; Venous thrombosis; Infections that affect the lymphatic pathways, such as filariasis, tuberculous lymphadenitis or lymphangitis. Understand how filariasis occurs, an infection also known as elephantiasis; Aortic aneurysm; Diseases that cause accumulations of tissues such as amyloidosis or sarcoidosis,
Other causes include pancreatitis, liver cirrhosis or other syndromes that disrupt blood or lymphatic circulation.
The name chylothorax is derived from the milky aspect that the liquid of the lymphatic vessels have, which is a result of the excess fat present in its composition, since the lymphatic vessels absorb part of the fat from the food in the intestines.
Lymphatic vessels have important functions in the body, ranging from the absorption of excess fluid from body tissues, the participation of the immune response and the transport of fats. The main and largest vessels of this type are the thoracic duct, located on the left and the lymphatic duct located on the right of the chest. Learn more about how it works and the importance of the lymphatic system.
How the treatment is done
Chylothorax treatment is indicated by the pulmonologist and includes ways to decrease the production of fluids in the lymphatic vessels, such as through a low-fat diet, fasting, feeding only through catheters in the veins or using medications such as Somatostatin or Octreotide, which act decreasing digestive secretions.
Chemotherapy or radiation therapy may be indicated to treat tumors or nodules that are obstructing the flow of lymphatic vessels. Surgery performed with fluid drainage or with corrections to changes in the lymph ducts may be necessary in cases where clinical treatment was not sufficient.
How to identify
Symptoms that can arise due to a pneumothorax include:
- Shortness of breath; Chest pain; Rapid breathing; Cough; Rapid heartbeat; Drop in blood pressure.
A chest X-ray can show the area of liquid accumulation, however, the chylothorax is only confirmed after a sample of this liquid has been drained, in a medical procedure called thoracentesis, which shows a milky liquid and will be analyzed in the laboratory..
Other tests that can be performed to aid diagnosis include chest ultrasound, MRI, or thoracic duct lymphography, for example, which help locate the lesion and differentiate it from other causes.
