Resumen :
El quilotórax es una causa infrecuente de derrame pleural (DP), con diversa etiología y tratamiento variable.
Objetivo: analizar los quilotórax atendidos a lo largo de 25 años.
Material y métodos
Se elaboró una base de datos a partir de las toracocentesis (TC) incluyendo edad, género, tiempo de evo... Ver más
Chylothorax is an infrequent cause of pleural effusion (PD) with diverse etiologies and variable treatment.
Objective: to analyze the chylothoraces treated over 25 years.
Material and methods
A database was elaborated from thoracentesis (TC) including age, gender, time of evolution, location, amount, biochemical characteristics of pleural fluid, treatment and final diagnosis. The Student's test (independent samples) was used to compare numerical values between groups and the Chi-square or Fischer's test for qualitative variables.
Results
Of a total of 3675 Tc corresponding to 2624 patients, 27 patients, 16 men (59%) and 11 women (41%) presented criteria of chylothorax (25) or pseudochylothorax (2), which corresponded to a prevalence of 1.02 % in patients with PD, and annual incidence 0.46/ 100000 h./year.
The mean age was 71±15 years, time of symptom onset 15±18 days. There were 25 exudates (93%) and 2 transudates (7%) with cholesterol 102±57, TG 665±812, protein 4±2, LDH 324±570, pH: 7.37±0.11 and lymphocyte predominance 68±12.
It was unilateral in 59% and bilateral in 41%, mild in 26%, moderate 48% and severe in 26%. The final diagnosis was 10 non-Hodgkin's lymphoma (37%), 1 Hodgkin's lymphoma (3.7%), 1 chronic lymphoid leukemia (3.7%), 4 chronic liver disease (14.8%), 2 heart failure (7.4%), 3 other neoplasms (11.1%), 6 others (22.2%). The group of others is broken down into the following: 1 cardiac and pleural amyloidosis, 1 lymphangioleiomyomatosis, 1 rheumatoid arthritis corresponding to a pseudochylothorax, 1 Waldeström's macroglobulinemia, 1 secondary to treatment with dasatinib in a patient with chronic myeloid leukemia an 1 idiopathic. Neoplasms: 1 pseudochylothorax corresponding to metastatic prostate carcinoma, 1 bronchogenic carcinoma, 1 gastric carcinoma. No significant differences were found when comparing the characteristics between patients with lymphoma and other etiologies, except for the number of repeated thoracentesis (p=0.02), which was lower in the lymphoma group. There were also no differences when comparing by gender. Local treatment consisted of evacuative thoracentesis (one or more) in 48% and drainage in 26%, with pleurodesis in these cases. In addition to general measures, chemotherapy was administered in 46%, depletive treatment in 23%, octeotride in 4% and none in 27%.
Conclusions
The prevalence of non-surgical or traumatic chylothorax in our environment is very low. Although the etiology is diverse, most are secondary to lymphoma and liver disease. Management is individualized in the context of systemic disease, rarely requiring pleurodesis.
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