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Etiology, clinical presentation, and diagnosis of chylothorax

John E Heffner, MD
Section Editor
V Courtney Broaddus, MD
Deputy Editor
Geraldine Finlay, MD


Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in leakage of chyle (lymphatic fluid of intestinal origin) into the pleural space. Chylous ascites can also flow into the pleural space.

The etiology, clinical presentation, and diagnosis of chylothorax will be reviewed here. The management of chylothorax, the evaluation and management of cholesterol effusions, and general issues regarding the evaluation and treatment of pleural effusions are discussed elsewhere. (See "Management of chylothorax" and "Clinical presentation, diagnosis and management of cholesterol effusions" and "Diagnostic evaluation of a pleural effusion in adults: Initial testing" and "Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology" and "Imaging of pleural effusions in adults" and "Mechanisms of pleural liquid accumulation in disease".)


Chylothoraces and cholesterol effusions both classically have a milky or opalescent appearance. However, their etiologies and therapy differ, making it important to distinguish them.

A chylothorax occurs when lymph fluid accumulates in the pleural space due to disruption or obstruction of the thoracic duct or its tributaries. Chylothoraces contain a high concentration of triglycerides in the form of chylomicrons, unless the patient has no dietary fat ingestion [1].

Cholesterol effusions (also known as a pseudochylothorax or chyliform effusion) are much less common than chylothoraces and contain a high concentration of cholesterol. These effusions typically occur in patients with thickened and sometimes calcified pleural surfaces in the setting of chronic pleural inflammation [2,3]. (See "Clinical presentation, diagnosis and management of cholesterol effusions".)

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Literature review current through: Nov 2017. | This topic last updated: Aug 23, 2017.
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