A Case of Idiopathic Chylothorax Treated with Pleuroperitoneal Shunt

ABSTRACT

Chylothorax is an accumulation of lymphatic fluid or chyle in the pleurual cavity resulting from a leak of the thoracic duct or one of its major divisions. If the loss of chyle persist, life threatening nutritional and immunologic deficiencies ensue. Initial conservative managements consist of tube thoracostomy drainage and dietary modification(low fat diet and total parenteral nutrition). In some refarctory cases, surgical intervention is required. Pleuroperitoneal shunt is an alternative surgical method recommended prior to thoracic duct ligation. The shunted fluid in the peritoneal cavity is reabsorbed by peritoenal lymphatic vessels running to join the right lymphatic duct. We experienced a case of chylothorax in a two-month-old female infant. Because there was no underlying disease to cause chylothorax, the diagnosis of idiopathic chylothorax was made. She failed to respond to conservative management and showed severe hypoalbuminemia and lymphopenia. On day 22, a pleuroperitoneal shunt was inserted between the right pleural cavity and the peritoneal cavity. Three weeks after insertion of the shunt, there was no fluid in the right pleural space. After one more week of observation, the shunt was removed.