Non-traumatic Chylothorax

In this condition the chylothorax occurs spontaneously without recent trauma. It can have associated with disease, such as lymphoma, previous radiation. One of the main challenges in patients with non-traumatic chylothorax is the detection of the source of the chylous leak.

Over the last several years our group developed the algorithm for evaluation and treatment of non-traumatic chylothorax (Figure).

class=”para”>The first step is to exclude the presence of the chylous ascites because it can track into the chest cavity through the diaphragmatic openings.

The next step in the evaluation of the patients is to perform the Dynamic Contrast Enhanced Magnetic Resonance Lymphangiography(DCMRL) in order to identify the location of the chylous leak (Figure)

If there is a leak from the thoracic duct, thoracic duct embolization is performed.

In some cases, the leak occurs through the retroperitoneal lymphatic masses, connected to the mediastinum. In these cases, interstitial lymphatic embolization is performed.