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Chylothorax 1406.e1

Chylothorax
VetBooks.ir Therapeutic and

diagnostic thoracocentesis

Analyze fluid

Culture and susceptibility Cholesterol/triglyceride Cytologic evaluation
(rule out infection) ratio 1 (Identify cell types, search
for chylomicrons, neoplasia,
Sterile infection)
Confirm chylothorax Predominantly lymphocytes

Search for associated
diseases

Cardiac workup No disease detected Thoracic workup
• Heartworm ELISA (radiographs or
• Echocardiography computed tomography,
+/- ultrasonography)
Idiopathic chylothorax

Begin medical management
Cardiomyopathy • Low-fat diet Cranial mediastinal Evidence of
or other heart disease • Rutin mass or pulmonary acute trauma
present • Octreotide mass detected

Medical therapy Successful Unsuccessful Thoracotomy Medical and/or surgical
Chemotherapy or therapy as indicated
mass excision

if recurrence

Continue indefinitely, Consult with surgeon
adjusting as needed regarding thoracic duct
ligation, pericardiectomy,
cisterna chyli ablation, etc.
Clinical Algorithms

Success Failure
Consider:
• Passive pleuroperitoneal drainage
• Active drainage
• Pleurodesis
Adapted from Bonagura JD, Twedt DC: Kirk’s current veterinary therapy XV, St. Louis, 2014, Saunders.
(Adapted from Bonagura JD, Twedt DC: Kirk’s current veterinary therapy XV, St. Louis, 2014, Saunders.)

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