Once the diagnosis of chylothorax is made by pleural fluid analysis, investigations should be performed to outline lymphatic vessels, identify the site of chyle leakage and finally to ascertain the cause of chylothorax. Imaging studies such as computerised tomography (CT) scans, lymphangiography and lymphoscintigraphy can be helpful. Lymphangiography implies the direct administration of an iodinated contrast agent into a cannulated lymph vessel. A simultaneous chest radiograph or CT will delineate the lymphatic anatomy. It is widely used in adults, as it is the best study to delineate the lymphatic anatomy and is very useful defining the site of chyle leak or obstruction. Successful identification rates of up to 81% have been reported in …show more content…
Lymphoscintigraphy may be an alternative to lymphangiography as it is a faster and less traumatic procedure. It has been used in children as an easy and non-invasive study with no irradiation. CT scan may be required to image the mediastinum, especially if non-traumatic chylothorax is suspected. 7 The approach to the management of chylothorax is the same regardless of the cause of the chylothorax. Up to the present, no treatments have been subject to randomized controlled trials. Most of the knowledge for the management of chylothorax in children comes from small case series. Here are the six principles in the management of chylothorax in children. The initial step in all cases is to perform thoracocentesis for diagnostic purposes, however if the size of the effusion compromises respiration, and/or if the collection is likely to reoccur, then a chest tube should be inserted. Quantification of drainage is useful to determine clinical improvement. Some centers have adopted a therapeutic approach with daily drainage as a guide for clinical improvement or failure ( (-- removed HTML --) 10 ml/kg/day failure, after 4 weeks of nonsurgical management).