Chyle Fistula Clinical Presentation

Updated: Aug 03, 2017
  • Author: Deron J Tessier, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History and Physical Examination

Because of the relatively low incidence of chyle fistulas, a high index of suspicion is required to make a timely diagnosis. Diagnosis usually is made after the patient has recovered from the injury and has started eating. [7]

Symptoms of chyloperitoneum include the following:

  • Nausea
  • Vomiting
  • Early satiety or anorexia
  • Abdominal discomfort or pain
  • Dyspnea due to chylous fluid causing abdominal distention and pressure on the visceral structures and diaphragm [8, 9]

Symptoms of chylothorax include the following:

  • Shortness of breath
  • Pleural effusion
  • Decreased cardiac preload due to a mediastinal shift from a large chylothorax

The characteristics of thoracentesis or paracentesis aspirate are as follows:

  • Odorless
  • Milky appearance that separates into a creamy layer when left to stand
  • Specific gravity greater than 1.012
  • Total fat composition of 0.4-4 g/L
  • Total protein greater than 30 g/L
  • pH greater than 7.0
  • Sterile fluid
  • Lipophilic globules when stained with Sudan III
  • Lymphocyte predominance on white blood cell differential