Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Knop Kinga, Kochanowska Anna, Piasecka Zuzanna, Kosieradzka Karolina, Drozd Małgorzata, Bodajko-Grochowska Anna. Etiological factors and treatment of chylothorax in paediatric patients - a systematic review. Journal of Education, Health and Sport. 2022;12(6):205-220. eISSN 2391-8306. DOI https://dx.doi.org/10.12775/JEHS.2022.12.06.021

https://apcz.umk.pl/JEHS/article/view/JEHS.2022.12.06.021

https://zenodo.org/record/6659431

The journal has had 40 points in Ministry of Education and Science of Poland parametric evaluation. Annex to the announcement of the Minister of Education and Science of December 21, 2021. No. 32343.

Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical Culture Sciences (Field of Medical sciences and health sciences); Health Sciences (Field of Medical Sciences and Health Sciences).

Punkty Ministerialne z 2019 - aktualny rok 40 punktów. Załącznik do komunikatu Ministra Edukacji i Nauki z dnia 21 grudnia 2021 r. Lp. 32343. Posiada Unikatowy Identyfikator Czasopisma: 201159.

Przypisane dyscypliny naukowe: Nauki o kulturze fizycznej (Dziedzina nauk medycznych i nauk o zdrowiu); Nauki o zdrowiu (Dziedzina nauk medycznych i nauk o zdrowiu).

© The Authors 2022;

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Received: 01.06.2022. Revised: 05.06.2022. Accepted: 18.06.2022.

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Kinga Knop¹, Anna Kochanowska¹, Zuzanna Piasecka¹, Karolina Kosieradzka¹, Małgorzata Drozd¹, Anna Bodajko-Grochowska²

¹Student Scientific Society, Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin

²Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin

Kinga Knop, kinga.knop03@gmail.com, ORCID: 0000-0002-7866-4830

Anna Kochanowska, aniako19@gmail.com, ORCID: 0000-0003-3595-9206

Zuzanna Piasecka zuz.pia@wp.pl, ORCID: 0000-0001-7896-0907

Karolina Kosieradzka, kosieradz.karolinaa@gmail.com, ORCID: 0000-0002-2446-6396

Małgorzata Drozd, drozd.malg@gmail.com, ORCID: 0000-0002-0710-2451

MD, PhD Anna Bodajko-Grochowska, annabodgroch@gmail.com, ORCID: 0000-0002-9464-5437

Abstract

Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe.

The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough.

This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments.

The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax.

This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient.

Key words: chylothorax; paediatrics; thoracic duct ligation; low fat diet