Chylothorax - Revision history

Kxl328 at 23:32, 26 February 2017

2017-02-26T23:32:16Z

← Revisión anterior		Revisión del 23:32 26 feb 2017
Línea 29:		Línea 29:
	*[[Thoracentesis]] with classically white, odorless, milky fluid:		*[[Thoracentesis]] with classically white, odorless, milky fluid:
	**Differentiate from empyema and pseudochylothorax		**Differentiate from empyema and pseudochylothorax
	**In congenital chylothorax, pleural fluid is ~~baseline~~ serous and becomes chylous when milk feedings start		**In congenital chylothorax, pleural fluid is serous and becomes chylous when milk feedings start
	**Pleural fluid analysis<ref>Tutor JD. Chylothorax in Infants and Children. Pediatrics. April 2014, VOLUME 133 / ISSUE 4.</ref>:		**Pleural fluid analysis<ref>Tutor JD. Chylothorax in Infants and Children. Pediatrics. April 2014, VOLUME 133 / ISSUE 4.</ref>:
	***Triglycerides > 110 mg/dL		***Triglycerides > 110 mg/dL

Kxl328 at 23:31, 26 February 2017

2017-02-26T23:31:45Z

← Revisión anterior		Revisión del 23:31 26 feb 2017
Línea 29:		Línea 29:
	*[[Thoracentesis]] with classically white, odorless, milky fluid:		*[[Thoracentesis]] with classically white, odorless, milky fluid:
	**Differentiate from empyema and pseudochylothorax		**Differentiate from empyema and pseudochylothorax
	***Triglycerides		**In congenital chylothorax, pleural fluid is baseline serous and becomes chylous when milk feedings start
			**Pleural fluid analysis<ref>Tutor JD. Chylothorax in Infants and Children. Pediatrics. April 2014, VOLUME 133 / ISSUE 4.</ref>:
			***Triglycerides > 110 mg/dL
	***Cholesterol		***Cholesterol
	***LDH		***LDH
			***Chylomicron analysis
	***Protein		***Protein
	***Culture and gram stain		***Culture and gram stain
	***Cell differential and count		***Cell differential and count
	*Serum LDH and total protein comparison		*Serum LDH, total cholesterol, and total protein comparison
			**Ratio of pleural fluid : serum cholesterol < 1.0 in chylothorax
			**In pseudochylothorax, this ratio will exceed 1.0<ref>Romero S, Martín C, Hernandez L, et al. Chylothorax in cirrhosis of the liver: analysis of its frequency and clinical characteristics. Chest. 1998;114(1):154–159.</ref>

	==Management==		==Management==

Kxl328 at 23:26, 26 February 2017

2017-02-26T23:26:49Z

← Revisión anterior		Revisión del 23:26 26 feb 2017
Línea 2:		Línea 2:
	*Lymphatic fluid in pleural space		*Lymphatic fluid in pleural space
	*Due to disruption or obstruction of the thoracic duct		*Due to disruption or obstruction of the thoracic duct
			*Differentiate from pseudocylothorax, a chronic cholesterol containing, chyliform pleural effusion not from thoracic duct disruption<ref>Light RW
			. Chylothorax and pseudochylothorax. In: Pleural Diseases, 6th ed. Philadelphia, PA: Wolters Kluwer Lippincott Williams and Wilkins; 2013.</ref>
	*Causes:		*Causes:
	**Malignancy (50%), especially [[lymphoma]]		**Malignancy (50%), especially [[lymphoma]]

Kxl328 at 23:20, 26 February 2017

2017-02-26T23:20:59Z

← Revisión anterior		Revisión del 23:20 26 feb 2017
Línea 25:		Línea 25:
	*+/- BNP, [[D-dimer]], [[Troponin]] to rule out other etiology		*+/- BNP, [[D-dimer]], [[Troponin]] to rule out other etiology
	*+/- Bedside [[lung ultrasound]]		*+/- Bedside [[lung ultrasound]]
	*[[Thoracentesis]] with fluid:		*[[Thoracentesis]] with classically white, odorless, milky fluid:
	**Triglycerides		**Differentiate from empyema and pseudochylothorax
	**Cholesterol		***Triglycerides
	**LDH		***Cholesterol
	**Protein		***LDH
	**Culture and gram stain		***Protein
	**Cell differential and count		***Culture and gram stain
			***Cell differential and count
	*Serum LDH and total protein comparison		*Serum LDH and total protein comparison

ClaireLewis at 02:05, 26 February 2017

2017-02-26T02:05:05Z

← Revisión anterior		Revisión del 02:05 26 feb 2017
Línea 9:		Línea 9:
	**[[Sarcoidosis]]		**[[Sarcoidosis]]
	**[[Amyloidosis]]		**[[Amyloidosis]]
	**[[~~Filariasis~~]]		**[[Lymphatic filariasis]]
	**Idiopathic		**Idiopathic

	==Clinical Features==		==Clinical Features==
			*[[Dyspnea]], tachypnea, [[hypoxia]]
			*Decreased breath sounds

	==Differential Diagnosis==		==Differential Diagnosis==
			{{SOB DDX}}

	==Evaluation==		==Evaluation==
	*Thoracentesis with fluid:		*[[CXR]]
			*[[ECG]]
			*CBC, BMP
			*+/- BNP, [[D-dimer]], [[Troponin]] to rule out other etiology
			*+/- Bedside [[lung ultrasound]]
			*[[Thoracentesis]] with fluid:
	**Triglycerides		**Triglycerides
	**Cholesterol		**Cholesterol
Línea 29:		Línea 35:

	==Management==		==Management==
			*Thoracic duct leaks close spontaneously in ~50% of patients<ref>Bender B, Murthy V, Chamberlain RS. The changing management of chylothorax in the modern era. Eur J Cardiothorac Surg. 2016 Jan. 49 (1):18-24. [Medline]</ref>
			*Treat underlying cause (e.g. chemoradiation for malignancy)
			*Refractory: pleurodesis, thoracic duct ligation, pleuroperitoneal shunt, pleurectomy

	==Disposition==		==Disposition==
Línea 35:		Línea 43:

	==See Also==		==See Also==
			*[[Pleural effusion]], [[empyema]]
			*[[Thoracentesis]]

	==External Links==		==External Links==

ClaireLewis: /* Background */

2017-02-26T01:55:51Z

Background

← Revisión anterior		Revisión del 01:55 26 feb 2017
Línea 2:		Línea 2:
	*Lymphatic fluid in pleural space		*Lymphatic fluid in pleural space
	*Due to disruption or obstruction of the thoracic duct		*Due to disruption or obstruction of the thoracic duct
	*~~Differentiate from~~ [[~~empyema~~]]		*Causes:
			**Malignancy (50%), especially [[lymphoma]]
			**Trauma (including iatrogenic)
			**[[Cirrhosis]]
			**[[Tuberculosis]]
			**[[Sarcoidosis]]
			**[[Amyloidosis]]
			**[[Filariasis]]
			**Idiopathic

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Background */

2017-02-26T01:53:16Z

Background

← Revisión anterior		Revisión del 01:53 26 feb 2017
Línea 1:		Línea 1:
	==Background==		==Background==
			*Lymphatic fluid in pleural space
			*Due to disruption or obstruction of the thoracic duct
	*Differentiate from [[empyema]]		*Differentiate from [[empyema]]

Mholtz: Formatting

2017-02-23T02:51:43Z

Formatting

@@ Línea 2: / Línea 2: @@
 *Differentiate from [[empyema]]
-==Workup==
+==Clinical Features==
 *Thoracentesis with fluid:
 **Triglycerides
@@ Línea 12: / Línea 18: @@
 *Serum LDH and total protein comparison
-==Sources==
+==Management==
-*Maldonado FM et al. Pleural Fluid Characteristics of Chylothorax. Mayo Clin Proc. 2009 Feb; 84(2): 129–133.

Kxl328: Created page with "==Background== Differentiate from empyema ==Workup== Thoracentesis with fluid: Triglycerides Cholesterol LDH Protein Culture and gram stain Cell differentia..."

2017-02-22T22:06:03Z

Created page with "==Background== *Differentiate from empyema ==Workup== *Thoracentesis with fluid: **Triglycerides **Cholesterol **LDH **Protein **Culture and gram stain **Cell differentia..."

Página nueva

==Background==
*Differentiate from [[empyema]]

==Workup==
*Thoracentesis with fluid:
**Triglycerides
**Cholesterol
**LDH
**Protein
**Culture and gram stain
**Cell differential and count
*Serum LDH and total protein comparison

==Sources==
*Maldonado FM et al. Pleural Fluid Characteristics of Chylothorax. Mayo Clin Proc. 2009 Feb; 84(2): 129–133.

Chylothorax - Revision history

Kxl328 at 23:32, 26 February 2017

Kxl328 at 23:31, 26 February 2017

Kxl328 at 23:26, 26 February 2017

Kxl328 at 23:20, 26 February 2017

ClaireLewis at 02:05, 26 February 2017

ClaireLewis: /* Background */

ClaireLewis: /* Background */

Mholtz: Formatting

Kxl328: Created page with "==Background== *Differentiate from empyema ==Workup== *Thoracentesis with fluid: **Triglycerides **Cholesterol **LDH **Protein **Culture and gram stain **Cell differentia..."

Kxl328: Created page with "==Background== Differentiate from empyema ==Workup== Thoracentesis with fluid: Triglycerides Cholesterol LDH Protein Culture and gram stain Cell differentia..."