Spontaneous Chylothorax in Children / 소아알레르기및호흡기학회지

ABSTRACT

PURPOSE: The purpose of this study was to review the cases of spontaneous chylothorax and its diagnosis, treatment, outcome, and complications. METHODS: We retrospectively reviewed the medical records of 10 patients who were diagnosed as spontaneous chylothorax in Seoul National University Children's Hospital between January 1990 and August 2001. We reviewed demographic data, pleural fluid analysis, treatment modalities, complications, and outcomes. RESULTS: Spontaneous chylothorax was identified in 10 patients including 5 infants with congenital origin. Chylothorax was noted in left(3 cases), right(2 cases) and bilatelly in five cases. Three of five infants with congenital chylothorax were born with hydrops fetalis and two were born prematurely. Pleural fluid laboratory findings were as follows WBC>1,000/microliter, lymphocytes 92.8+/-9.9%, protein 3.9+/-2.7 g/dL, triglyceride 994+/-825 mg/dL, cholesterol 46.6+/-26.7 mg/dL. All cases were treated initially with a combination of repeated thoracenteses and/or pleural drains, total parenteral nutrition, medium-chain triglyceride based formula or low fat diet. Seven cases responded to conservative treatment. One infant underwent successful thoracic duct ligation. Chylothorax persisted in 2 cases. There was an initial response to steroid treatment in 1 infant who was considered Noonan syndrome, but chylous effusion increased during the tapering of steroid. CONCLUSION: Conservative treatment was successful in 70% of the patients. A precise diagnosis, proper treatment, and prevention and treatment of complications are important in the management of chylothorax. Familiarity with the therapeutic options and appropriate timing for surgical intervention will be required.