Pleural Effusion

Question 1

Chylothorax management

Answer 1

NPO or non-fat, non-dairy diet
IVF
TPN
IV octreotide
Thoracic duct embo (>70% success rate by experience IR)
If refractory, chemical pleurodesis or operative ligation of thoracic duct.
* Of note, output of >1500 will usually not resolve with conservative management alone

Question 2

Pathognomonic findings of chylothorax

Answer 2

High Output chest drain (usually but not always milky appearing)
Triglyceride level of thoracic fluid >110
Cell counts lymphocytes > 90%