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Etiology of chylothorax

Etiology of chylothorax
Etiology Number of cases*[1] (percent) Number of cases¶[2] (percent)
Total nontraumatic PLUS traumatic cases 191 (100) 203 (100)
Nontraumatic
Malignant neoplasia
  • Lymphomatous
  • 70 (37)
  • 23 (11)
  • Nonlymphomatous (eg, primary lung, mediastinal, metastatic extrathoracic malignancies, sarcoma, leukemia)
  • 17 (9)
  • 11 (5)
Total malignant neoplasia cases = 87 (46) 34 (17)
Nonmalignant
  • Idiopathic
  • 26 (14)
  • 13 (6)
  • Miscellaneous (benign tumors, lymphangioleiomyomatosis, intestinal lymphangiectasis, protein-losing enteropathy, regional ileitis, pleuritis, cirrhosis, thoracic aortic aneurysm, lupus, tuberculosis, sarcoidosis, amyloidosis, venous thrombosis, mitral stenosis, nephrosis, thyroid goiter, tuberous sclerosis, filariasis, heart failure, Down syndrome, Noonan syndrome, other diagnoses* (please refer to UpToDate text for additional causes)
  • 25 (13)
  • 55 (27)
Total nonmalignant cases = 51 (27) 68 (33)
Total nontraumatic cases = 138 (72) 102 (50)
Traumatic
  • Surgical (cardiovascular, aortic, thoracoplasty, esophagectomy, lobectomy, pneumonectomy, mediastinal mass resection, Bochdalek herniorrhaphy, transabdominal vagotomy, central venous catheterization, esophageal endoscopic sclerotherapy, neck surgery, spine surgery, embolization for pulmonary arteriovenous malformations, pacemaker insertion)
  • 48 (25)
  • 97 (48)
  • Nonsurgical (penetrating or nonpenetrating trauma to the neck, thorax, and upper abdomen, straining, coughing, yawning, vomiting)
  • 5 (3)
  • 4 (2)
Total traumatic cases = 53 (28) 101 (50)
* The Valentine et al case series [1] did not provide diagnoses for 10 patients so these cases were categorized in the table as "other diagnoses" in the Miscellaneous category.
¶ The lower incidence of chylothorax related to lymphoma in the earlier Doerr series [2], compared with the older Valentine series [1], likely relates to the earlier diagnosis of lymphoma and prompt initiation of effective therapy, prior to development of chylothorax.
References:
  1. Valentine VG, Raffin TA. The management of chylothorax. Chest 1992; 102:586.
  2. Doerr CH, Allen MS, Nichols FC 3rd, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005; 80:867.
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