All issues > Volume 34(4); 1991

Original Article

J Korean Pediatr Soc. 1991;34(4):497-506. Published online April 30, 1991.

A clinical observation on chylothorax in childhood.

Mi Jin Jung¹, Joon Jai Kim¹, Young Ah Lee¹, Chung Il Noh¹, Jung Hwan Choi¹, Chong Ku Yun¹

¹Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea

Received: September 28, 1990;  Accepted: November 29, 1990.

Abstract

Fourteen patients who had developed a chylothorax in childhood during a ten year period, from Jan. 1979 to July 1989, were reviewed by their hospital records. The chylothoraces occurred most frequently as complications of cardiothoracic surgeries in eight patients(57%). Four cases followed extrapericardial operations such as ligation of PDA and take-down of Blalock-Taussig shunt, and four cases followed intrapericardial operations such as corrective operations of Fallofs tetralogy and Fontan operation. The latent period was 5 to 44 days (mean 13.3 days) and five cases had bilateral sided effusions(63%). Others were three cases of congenital chylothorax and one case associated multiple lymphangiomatosis of bone, and one case associated complete obstruction of left internal jugular vein due to thrombosis which developed after Fontan operation. Two cases of congenital chylothorax had had difficult delivery history and left sided chylothorax. Not all cases showed milkish appearance on initial thoracentesis, especially on NPO state, but the cellular component was primarily lymphocytic (64—100%). All cases were treated initially with chest tube drains and diet theraphy-MCT oil and fat free diet or skim milk-or parenteral nutrition on NPO state. Twelve cases (86%) were improved during 6 to 40 days of chest drains. Two cases received pleurodesis, of whom one received operations of removal of leaking lymphatic sac with improvement of chylothorax. Empyema and malnutrition were complicated after long standing drains. In our review, chylothoraces followed frequently intrapericardial surgery in comparison with other reports. The conservative management had a good result in most of chylothoraces of variable causes. Congenital chylothoraces were well controlled by conservative management and had a good prognosis. After Fontan operation anticoagulant therapy would be used for the prevention of throm- bosis. Ifs thought that a further study of nutritional method and appropriate time for the operative management should be made.

Keywords :Chylothorax;Childhood