History and Physical Examination

History

Usually, patients with chylothorax remain asymptomatic until a large amount of chyle accumulates in the pleural space.

The average latent period between the insult and the onset of symptoms is 7-10 days. Symptoms include the following:

Dyspnea
Tachypnea
Classic symptoms of pleural effusion

Rarely, patients may experience a rapid accumulation of fluid in the pleural space, causing a tension chylothorax. This is of particular concern following a pneumonectomy. These patients experience a rapid hemodynamic and respiratory compromise, similar to the classic tension pneumothorax.

Physical Examination

Findings on physical examination are nonspecific and include the following:

Decreased breath sounds
Shifting dullness

If the patient has an existing chest tube, drainage of 400-600 cc per 8-hour period is concerning for a chylous leak, particularly in postsurgical patients.

Differential Diagnoses

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Media Gallery

This anteroposterior upright chest radiograph shows a massive left-sided pleural effusion with contralateral mediastinal shift. Image courtesy of Allen R Thomas, MD.
This computed tomography scan of the chest of a 3-year old child reveals a left-sided effusion and underlying parenchymal infiltrate and atelectasis. Image courtesy of Ibrahim Abdulhamid, MD.

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Author

Sasha D Adams, MD Assistant Professor, Department of Surgery, Division of Trauma, Critical Care and Emergency General Surgery, University of North Carolina, Chapel Hill; Surgeon, Trauma, Critical Care and Emergency General Surgery, University of North Carolina Memorial Hospital

Sasha D Adams, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Association of Women Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

James Cipolla, MD Attending Surgeon, Department of Traumatology and Critical Care, Program Director, Surgical Critical Care Fellowship, St Luke's University Hospital; Associate Professor of Surgery, Temple University School of Medicine; Assistant Clinical Professor of Surgery, University of Pennsylvania School of Medicine

James Cipolla, MD is a member of the following medical societies: American College of Surgeons, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Mounzer Al Samman, MD Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Texas Tech University School of Medicine

Mounzer Al Al Samman, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association

Disclosure: Nothing to disclose. Rosemary Kozar, MD, PhD, Assistant Professor, Department of Surgery, Division of General Surgery, University of Texas at Houston School of Medicine

Disclosure: Nothing to disclose.

Chylothorax Clinical Presentation

History and Physical Examination

History

Physical Examination

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