Cyclothorax is a rare condition that has a high incidence of morbidity as well as mortality. Learn more about this serious condition in the following paragraphs.
What is Cyclothorax?
When the chyle leakage occurs from the lymphatic system due to thoracic duct damage in the pleural space, it leads to cyclothorax. This leakage mostly occurs on the right side of the chest. This condition can occur as a congenital disorder or may happen after a person suffers from trauma (iatrogenic form).
In case of neonates, the condition is noted if the baby is suffering from birth asphyxia and respiratory insufficiency. The neonate needs to be resuscitated and put on artificial ventilation in this case. In case of trauma, it usually happens after one undergoes an intrathorasic surgery.
The leakage of chyle and lymph causes loss of essential proteins, immunoglobulins, fats, vitamins, electrolytes and water. Thus, leading to nutritional deficiency, respiratory problems and the patient will continue to deteriorate.
Clinical Features of Chylothorax
Patients exhibit symptoms based on the rate of chyle loss and the effect of the leakage. The loss leads to hypovolemia and respiratory trouble. This happens due to the fluid filling up the pleural space. Also, loss of protein, fats and vitamins leads to malnutrition.
Loss of immunoglobulins makes the patient vulnerable to opportunistic pathogens. Loss of electrolytes leads to hypocacemia and hypotremia. Patients usually come in with chest pain and cough. The condition is usually diagnosed by a chest X-ray taken for differential diagnosis.
Some of the conditions that may lead to cyclothorax include:
- Trauma to thoracic duct or lymphatic vessel during a thoracic surgery
- Laceration to thoracic duct due to vertebral fractures
- Tuberous sclerosis
- Nephrotic syndrome
In case of neonates, the condition can arise due to:
- Congenital heart disease
- Down syndrome
- Turner syndrome
- Trachea-esophageal fistula
Suspected cases of cyclothorax are investigated by fluid analysis. The fluid appears white and milky. Lab analysis will confirm high levels of triglycerides in the form of chylomicrons. A chest X ray and CT scan will help in spotting the location of the leak.
The treatment options for cyclothorax are limited. The most important aspect of treatment is drainage of the pleural space to prevent damage to other organs. Surgical intervention for formation of pneumoperitoneal shunt. This helps in prevention of loss of essential triglycerides from the leak.
Cyclothorax is a rare condition that can be managed with surgery in case of large leaks or in those who are malnourished or immunologically weak. The condition has poor prognosis, if not treated properly
Date last updated: April 01, 2015