from:
http://www.vh.org/Providers/TeachingFiles/PAP/NeonatalChestDiseases/ChyloTX.
html
Neonatal Chest Diseases
Chylothorax
Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
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Clinical Presentation:
Respiratory distress. Fifty percent present in first 24 hours of life, and
70% present within one week of birth.
Etiology/Pathophysiology:
Chylothorax is the accumulation of lymphatic fluid in the pleural space.
Abruptly elevated venous pressure during delivery can lead to thoracic duct
rupture which leads to intrapleural accumulation of lymph fluid. Initially
the fluid is serous, but turns chylous after milk feedings. This is the most
frequent cause of a large pleural effusion in newborn. It is rarely
bilateral, and is rarely associated with generalized lymphangiomatosis. It
is diagnosed and usually managed successfully via thoracenteses.
Pathology:
Not applicable
Imaging Findings:
Usually unilateral and usually on right side (60%). It is difficult to find
the exact site of lymph extravasation with contrast studies.
DDX:
Erythroblastosis fetalis
Congestive heart failure
Cystic adenomatoid malformation
Urine ascites
Hemothorax from trauma
Pneumonia
References:
See References Chapter.
a chest Xray of the condition in a neonate can be seen here:
http://www.vh.org/Providers/TeachingFiles/PAP/NeonatalChestCapt/ChyloTX03.ht
ml
and a discussion of surgical management can be seen here:
http://www.jpedsurg.org/abs/abs18_6/114181.html
and some definitions from:
http://www.google.com/search?q=cache:www.njc.org/fp10.html+Chylothorax+neona
tal+milk&hl=en
Chyle
The milky substance taken up by the lacteals (intestinal lymphatics) from
the food in the intestine during digestion. It consists of lymph and
droplets of triglyceride fat in a stable emulsion. It passes into the veins
by the THORACIC DUCT, becoming mixed with blood. (From Dorland, 27th ed)
Chylothorax
The presence of chyle in the thoracic cavity. (Dorland, 27th ed)
and a discussion between parents of preemies on Preemie-L
http://lists.vicnet.net.au/cgi-bin/lwgate/PREEMIE-L/archives/preemie-l.9809/
Author/article-1107.html
Carla
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