ISSN 2398-2993      

Chylothorax

obovis
Contributor(s):

Ben Dustan

Mike Reynolds

Synonym(s): rupture of thoracic duct


Introduction

​Chylothorax is rare in cattle.
  • Cause:
    • Results from erosion or rupture of the thoracic duct.
    • Majority considered idiopathic.
    • Occasionally trauma to thoracic inlet, thoracic neoplasia, lymphatic hypertension, heart failure, thoracic vertebrae fracture. 
  • Signs:
    • Depend on volume and rate of chyle accumulation.
    • Dyspnea is most common with marked forceful inspiration and delayed expiration.
    • Coughing if chronic.
  • Diagnosis: thoracocentesis and fluid/aspirate analysis, ultrasonography and radiology can be useful.
  • Treatment
    • Ideally treat the underlying cause. 
    • As many cases are idiopathic and economic constraints are usually significant,  treatment focuses on occlusion of the thoracic duct and supportive symptomatic treatment (antimicrobials when indicated, to cover probable mixed bacterial flora with choice being dictated by culture and sensitivity, anti-inflammatories).
  • Prognosis
    • Largely dependent on the underlying cause and whether treatment is possible (surgical, medical, economical).
    • Guarded long-term prognosis in most cases. 
      • Longstanding chylous effusion can result in fibrosing pleuritis, significant respiratory compromise, increased susceptibility to respiratory infections and possible restrictive pericarditis.

Pathogenesis

Etiology

  • Idiopathic (majority of cases in cattle).
  • Trauma.
  • Neoplasia.
  • Cardiac failure (Congestive heart failure Congestive heart failure, Cardiomyopathies Cardiomyopathy, traumatic Pericarditis Pericarditis etc).
  • Congenital (congenital deformities of the thoracic duct, heart valves, Tetraolgy of Fallot Tetraolgy of Fallot etc)
  • Lymphatic hypertension.

Timecourse

  • Depends on etiology, acute or chronic.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Cruz A M, Riley C B, MacDonald D G & Ferguson J G (1995) Use of mesenteric lympangiography in a calf with chylothorax and chyloperitoneum. JAVMA 206 (10), 1567-71 PubMed.

Other sources of information

  • Smith (2002) Large Animal Internal Medicine. 3rd edn. pp 967.

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