Chylothorax
| Classification according to ICD-10 | |
|---|---|
| J94.0 | Chylous (pleural) effusion |
| ICD-10 online (WHO version 2019) | |
The chylothorax is an accumulation of lymph fluid (Greek chylos = 'milky juice') in the area of the pleural cavity . This usually happens through an injury to the so-called breast milk duct ( ductus thoracicus ). This leads up to four liters of lymph from a large part of the body back into the venous blood every day. In the event of injuries, this lymph runs into adjacent structures ( chylorrhea ). In addition to the chest cavity, especially in the case of severe trauma, the lymph can also run into the pericardium (so-called chylopericardium ) and lead to pericardial tamponade . If the lymph remains limited to the middle space ( mediastinum ), one speaks of a chylomediastinum .
causes
- Spontaneous rupture
- intraoperative injury (especially after operations on the esophagus , heart and aorta )
- pointed and blunt trauma
- Relocation of the thoracic duct (e.g. due to a tumor )
- Gorham-Stout Syndrome
Symptoms
From a volume of about two liters it comes in adult humans typically by displacement of the lungs and mediastinum to dyspnea and tachycardia . Chylous puncture or exudate can lead to the development of a pleural effusion .
Diagnosis
- Clinical: Attenuation of the breathing noise in the basal sections of the lungs and a dampening of the percussion .
- X-ray : In the chest X-ray, shadows can be seen in the deep-lying sections of the pleural cavity.
- Puncture : The puncture fluid is usually milky and sterile . Laboratory chemistry shows that it contains an increased fat content (recognizable by the determination of triglycerides and cholesterol in the pleural punctate)
therapy
By repeatedly relieving the chylothorax (e.g. via a Bülau drainage ) one tries to wait for the injured part of the thoracic duct to stick. This can be supported by a special diet ( MCT diet with medium-chain fats ), in which the short- and long-chain fats transported via the lymphatic system are avoided in the food. If there is no improvement after 1–2 weeks, the injury site is usually treated surgically and the thoracic duct is restored by direct suturing or, if the genesis is unclear, pleurodesis is performed.
literature
- Sigrid Wiesner, Elena Loch, Wibke Uller, Reiner Neu, Hans-Stefan Hofmann, Michael Ried: Treatment options for chylothorax in adults. In: Surgical General. 21st year, 2020, 1st issue, pp. 35–39.
Individual evidence
- ↑ Berthold Jany, Tobias Welte: Pleural effusion in adults - causes, diagnosis and therapy. In: Deutsches Ärzteblatt. Volume 116, No. 21, 2019, pp. 377-385, here: pp. 379 and 381 f.
