Dayton Children’s Hospital

Chylothorax

What is chylothorax?

Chylothorax is an accumulation of lymph fluid around the lungs. The excess fluid around the lungs can make it difficult for your baby to breathe. In some cases, chylothorax only affects one lung, but in other cases it can affect both lungs.

The exact cause of chylothorax in newborns is often unknown. Most cases of chylothorax are congenital (present at birth). It can also be caused by trauma from surgery.

How is chylothorax diagnosed?

Chylothorax is sometimes discovered during pregnancy during a routine ultrasound. In other cases, it is not diagnosed until after the baby is born and begins to show symptoms with difficulty breathing. Common symptoms of chylothorax include shortness of breath, rapid breathing, as well as difficulty feeding

While examining your baby, the doctor will first listen to your baby’s lungs with a stethoscope. If the doctor thinks your baby may have fluid in the lungs or if your baby is showing symptoms of chylothorax, tests may be done to confirm the diagnosis. Common tests for diagnosing chylothorax include a chest X-ray, an ultrasound, or thoracentesis, which has a needle drain the chylothorax, and pleural fluid analysis.

How is chylothorax treated?

The treatment goals for chylothorax are to drain the fluid and keep it from building up again and to determine the cause so that it can also be treated.

If discovered during pregnancy, chylothorax is sometimes treated while the baby is still in the womb. This is done by inserting a drain into the baby’s chest. The drain allows removal of the fluid from around the baby’s lungs into the amniotic fluid. If the fluid is not drained the lungs may not grow to a normal size. Draining the fluid while the baby is still in the womb, if determined to be necessary by the Maternal Fetal Specialist, may give the baby’s lungs a better chance growing to a normal size.

If chylothorax is not diagnosed until after your baby is born, there are several possible treatment methods. The most common is called a thoracentesis, a procedure in which a needle is inserted into the pleural space and the fluid is drawn out into a syringe. This helps your baby to breathe better and allows doctors to examine the fluid to try to determine why it is there.

Another common treatment method for chylothorax is inserting a chest tube through a small incision in the baby’s chest to drain the excess fluid. This procedure allows for ongoing drainage of the fluid without the need for repeated thoracentesis.

Your baby may also need to be put on a fat-free or low fat diet to reduce the body’s production and accumulation of fluid around the lungs.

Occasionally, an IV medication called somatostatin (octreotide) can be used if the fluid continues to accumulate after drainage.

How will chylothorax affect my baby during and after surgery?

Whether or not your baby will need surgery will depend on the amount of fluid buildup and whether or not the fluid buildup is recurring. Many instances of chylothorax are mild, in which case they can sometimes resolve themselves or be cured by drainage of the fluid. Rarely, the fluid continues to accumulate despite aggressive medical intervention.