Chylothorax

What Is Chylothorax?

Chylothorax is a rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity. Lymph is a fluid containing white blood cells and proteins that moves through your lymphatic system and drains into your bloodstream.

Symptoms of chylothorax

An early symptom of chylothorax is shortness of breath, which occurs as chyle collects in your chest cavity and compresses your lungs.

Causes of non-traumatic chylothorax

Non-traumatic chylothorax occurs without obvious trauma. It may happen spontaneously, but is often associated with the following:

• Lymphatic disorders or malformations
• Some syndromes, including Noonan syndrome, which is a genetic disorder that prevents normal physical development
• Lymphoma

Penn Medicine researchers recently discovered that chylothorax is commonly caused by leakage of lymph from the thoracic duct into the pleural space (the space around the lungs).The thoracic duct is the largest lymphatic duct and typically transports lymph from the body to veins. When this flow isn't optimal the lymph fluid can leak backward and cause chylous pleural effusions.

Another possible cause of chylothrorax is chylous ascites, which is a leakage of intestinal lymph in your peritoneal (abdominal) cavity. With chylous ascites, chyle from the abdomen travels into your chest cavity through the natural opening in your diaphragm.

Diagnosis of Chylothorax

To diagnose chylothorax, we will take a sample of your chest fluid and test it for a high concentration of triglycerides and lymphocytes. We'll also perform MR lymphangiography to determine the location of the leak.

MR lymphangiography study video showing abnormal lymphatic flow to the right lung

Thoracic duct injection through the microcatheter demonstrates abnormal pulmonary lymphatic flow

Penn Medicine interventional radiologists developed a diagnostic algorithm that determines our treatment approach:

Chylothorax Treatment at Penn

Penn Medicine pioneered the percutaneous (through the skin) treatment of non-traumatic chylothorax. Over the past 20 years, we have refined this minimally-invasive treatment approach, and our cure rate is close to 100 percent.

During a percutaneous thoracic duct embolization, we will inject a special contrast material into your groin lymph nodes. We'll then access your thoracic duct with small needle and catheter and inject the contrast into your thoracic duct to determine the cause of your chylothorax.

The source of the leak is then blocked (embolized) with special endovascular coils and endovascular glue.

Percutaneous thoracic duct embolization procedure

If chylous ascites are causing chylous fluid to accumulate in your chest, then embolization will not be performed, and the chylous ascites will be treated instead.

Penn Programs & Services for Chylothorax