ABSTRACT
A chylothorax is a pleural effusion composed of lymphatic fluid. In children, the most common etiology is iatrogenic following an operation within the posterior mediastinum. Any child with the suspicion of having a chylothorax mandates an analysis of the pleural fluid obtained by thoracentesis or tube thoracostomy. A trial of medical management is always indicated before operative management for a chylothorax is attempted. The surgical armamentarium for the management of refractory chylothoraces includes thoracic duct ligation, pleurodesis, pleurectomy, and pleuroperitoneal shunts. Pleurectomy, which involves manual stripping of full-thickness parietal pleural, is a preferred technique at many institutions in the setting of chylothorax secondary to central venous obstruction or diffuse lymphatic leak. The placement of a shunt is another potential option in the treatment of chylothorax. The majority of chylothoraces, particularly those that are congenital in etiology, cease spontaneously under proper medical management.
