Chylothorax

Question: Anyone with a dog that has had a chylothorax and was treated successfully? Our 2 yo dog was diagnosised with this and they are recommending surgery...but the stats vary a lot. Has anyone had a dog successfully treated by conservative methods such as diet and Rutin or successfully by surgery?

Answer: Chylothorax is fairly uncommon in dogs and cats, is usually secondary to other conditions or diseases, and can be difficult to treat Treatment of chylothorax is dependent on the cause of the effusion. Both medical and surgical therapy have been used. But again, it depends on the cause as to which is more appropriate. Sugery is usually suggested when medical treatment has failed- or is determined to be ineffective in the situation. While prognosis is not generally good- there was a recent study of 8 dogs that underwent a surgical proceedure. Seven dogs were free of clinical signs related to chylothorax at last follow-up and One dog was euthanatized 2 months after surgery because of lack of improvement. the conclusion was that the surgery they were performing resloved the issues of Chylothorax in 88% of canine patients. Although they say more studies need to be made. In some cases (not all), conservative methods (such as diet and Rutin) have not been successful.. Although there are cases where an underlying disease has not been diagnosed, where a vet may suggest a chest tap to remove fluids, and low fat diet can help along with medications as a course of treatment before surgery. Rutin is still being clinically tested to see how helpful its effects are. So its considered experimental.

Question: My 4 year old dog has been diagnosed with Idiopathic Chylothorax.? We are considering surgery but it is very expensive and it does not sound that promising....Does anyone have any first hand experience with this disease?

Answer: There is an article about that type of disease on this web site. It talks about a Vaccine that can be given to certain dogs. Maybe this will help you to understand just what it is and how it can be treated. http://www.ecvim-ca.org/ You can also go into Google and type in "Idiopathic Chyothorax for Dogs" and it too will give you a whole lot of information. Hope this Helps you

Question: What is a MCT diet for chylothorax? My brother has NHL and continues to build up chyle in pleura.? He has had repeated thoracentesis to no avail. Dr. suggested MCT diet but I know nothing about it. Does anyone have specific infomation?

Answer: An MCT diet, or medium chain triglyceride diet, is one form of a ketogenic diet. A ketogenic diet is one that is high in fat and extremely low in carbohydrate. It is often used to treat epilepsy, but (obviously) has other uses as well, such as in your brother's case of non-Hodgkins lymphoma. It works by inducing ketosis and its related effects, a condition typically only present in starving individuals. Without getting too technical, in ketosis, the body stops using glucose as an energy source and starts using fat. Normally we don't want this to happen, but in the case of your brother, it could cause a reduction in chyle buildup because the body would be forced to use the chyle (which is just lymphatic fluid rich in fat and other nutrients) as an energy source. I have included below in the source information a page with guidelines for a few different ketogenic diets. The page is geared toward the ketogenic diet as a treatment for epilepsy, but the dietary guidelines themselves are the same (the ketogenic diet is the ketogenic diet, regardless of what you are using it for). Hope this helps, and best of luck to your brother.

Question: Feline Chylothorax. Anyone have their cat cured? I know that treatment is dependent upon what is causing the chylothorax and actually treating that, but my cat was only diagnosed tonight and I have to wait two days for the blood work and labs. Thoracocentesis took his lung capacity from 30% to 70-80% and he's on an antibiotic and a diuretic. He's currently sleeping off the anesthesia. I guess I'm maybe just looking for some positive stories to keep my spirits up until I get the official news. Anyone? Oh sorry. I forgot. My cat is male. A Siamese mix. 11 yrs old. The vet does not think it could be "the big 'c'" and is hoping it is just from some unknown trauma because he is in otherwise great health. Heart sounds good, etc. He told me that on a 1-10 scale my level of worry should be around a 3 or 4 but I feel like he's just telling me that because we don't have the cause yet and there is no sense to worry me until an official diagnosis is found. Thanks! Update: lab work and CBC panel mostly great news. All organs great. No diseases, viruses, etc. A high level of eosilophils (sp? I think I spelled that right) which usually is an allergic reaction or a parasite. Vet is thinking it is very odd. The effusion is NOT milky at all (typical of chylothorax). If it IS a chylothorax then it is presenting very strange. We are praying he's had a kind of trauma (weird hoping for THAT) to cause the fluid to be leaking and that he'll simply heal, because he's otherwise healthy. He's on antibiotics and lasik (diuretic) to pull the rest of the fluid out. I have to wait two weeks before his next xrays. I give him 1/4 of a pepcid 30 minutes before his meds because they upset his stomach (he vomits). This morning he fought taking meds and the stress triggered a wheezing attack. I worry the fluid will come back and he'll hide the difficulty. Vet said steroids possible. I HAVE heard of Rutin (pubmed article) but vet doesn't think my cats case fits. I have also heard of getting chylothorax cats on low fat diets. Hills Science Diet r/d is by perscription only, but you can make their recipe at home with no prescription: http://www.holisticat.com/rxdiets.html (The second recipe down is the "reducing diet" (r/d).) I'm so sorry your kitty is in the hospital. She sounds very sick. :( How terrible! I am fortunate I suppose that my boy is at least well enough to be home with me and his feline-sister, Sadie. We will keep you in our thoughts!! I have switched my status to "accepts emails" so feel free to write me to keep me posted. I promise to try to respond!

Answer: I'm really sorry. That's hard. Chylothorax is a very serious diagnosis. Rarely have I seen a cat pull through, but it is possible. There are surgeries that can be done, but they are generally very expensive and not very successful. here is a website with some decent information: http://www.sniksnak.com/cathealth/chylot…

Question: Anyone have sucess w/Rutin pills for Chylothorax? Our 14month old Bullmastiff pup was just diagnosed with Chylothorax. Has anyone had positive results with Rutin? I hate the thought of letting him go the next time he gets sick. The only other option we were told is surgery over $5,000 and only a 60% sucess rate..

Answer: so sorry for your precious dog! I have not heard of the condition. All you can do is to try the meds and see if it helps. Best of luck with your pooch!

Question: My cat has chylothorax please help!? She is 4 and has stopped eating.. we are force feeding her baby food and trying to get hold of some Rutin which we have heard might help... she has been tapped twice but finds it extremely traumatising.. desperate to help her... Krista - thank you so much for your info. yes they are doing tests.. they can't find any underlying condition.. they don't know what caused it.. she is still drinking water and we have put glocose in.. the thing is she is back at home for now because become completed traumatised when visiting vet.. She is on 3 drugs - one is diuretic, one is antiinflammetry and one is appetite stimulant.. so she is drousey as well. but she is so weak.. =0( She is on 3 drugs - one is diuretic, one is antiinflammetry and one is appetite stimulant.. so she is drousey as well. but she is so weak.. =0(

Answer: Has your vet done tests to determine the underlying cause of the chylothorax? It's not usually a stand alone problem. Is she drinking water? When a cat stops eating and drinking it's very serious (especially when she stops drinking). So take her to the vet again. It sounds like the vet should put a drainage tube in, so that your cat doesn't need to be frequently 'tapped'. "Measures to improve the cat’s respiratory capacity are usually the first steps in therapy. Fluid can be drained from the pleural space with a syringe and needle. In almost all cases, the fluid will reform and a drain tube will need to be surgically implanted to facilitate daily drainage. This tube may be left in place until chyle accumulation stops. If fluid is still accumulating after 1-2 weeks, thoracotomy (exploratory chest surgery) may be recommended to search for the underlying cause or to repair a torn thoracic duct which will not heal. When the cause is trauma, most cats will heal on their own and surgery will not be needed. Feline chylothorax is a disease under active research. Some new treatment modalities may be on the horizon. Regardless, the most successful therapy will be directed toward treating the underlying disorder."

Question: Persistent Chylothorax? I am mainly looking for the insight of someone who specializes in cardiac surgery or thoracic duct surgeries. My son had heart surgery when he was a week old. His right lung was collapsed post op. He went into cardiac arrest 4 hours post op. He was placed onto ECMO (life support) for 6 days. Chylothorax started within a week after ECMO. The chylothorax was first treated with portagen then TPN for two months. During which time 3 separate ligations of the thoracic duct were preformed. All treatments were unsuccessful. He had blood clots in the neck and center chest area from the life support. Steroids were started and discontinued due to infection after 10 days. The outflow of Chylothorax ranged from 500 MLs - 1000 MLs bilateral per day. Respiratory distress was onset three times due to chest tube clogs or in proper drainage. More to Cont. He remained intubated during his chylothorax due to acute respiratory distress. His left lung was punctured by a chest tube during a attempt to reinsert. His Chylothorax just resolved after 3 months with no apparent reason for resolving. Now, there is a 11month old in the ICU with the exact same scenario. TPN, steroids, poragen, 1 ligation of the thoracic duct the treatments have shown no improvements. Both infants were on ECMO both suffering blood clots. Her output of Chyle per day is around 600MLs she is on month 3 of Chyle. I am convinced the pressures from the blood clots in both children are making it difficult for the thoracic duct to heal. When in the Cath lab they attempted to remove the 11 month old's blood clot without success. Besides from using a shunt or growth hormones what are the other options for treatment? Both children also had acute kidney failure. My son's liver is enlarged from the prolonged TPN. The 11 month old's liver is only slightly enlarged. Wouldn't you think that if the Chylothorax does not get resolved by TPN to allow the children to have non fat formula like poragen or monagen? So that it doesn't damage their liver.

Answer: This Topic might help you out: Department of Surgery, Children's Medical Center, University of Virginia Health Sciences Center, Charlottesville 22908. Between June 1981 and June 1988, we placed pleuroperitoneal shunts in 16 patients for the management of refractory chylothorax on the Pediatric Surgical Service, University of Virginia. The cause of the chylothorax was caval thrombosis from central venous catheters in 5 patients, idiopathic in 3, and mediastinal lymphangioma in 2, and in 6, it developed after a cardiac procedure. Chylothorax in each patient was unresponsive to thoracentesis, tube thoracostomy, and dietary manipulations. A Denver double-valved shunt system is currently employed and is implanted using general anesthesia. Manual pumping is required postoperatively for several months. Twelve (75%) of the 16 patients had excellent results with complete elimination of the chylothorax and resolution of symptoms. In 10 of these 12, the shunt has been removed. Four had an unsatisfactory result: 3 had inferior vena cava hypertension, and 3 were low-birth-weight premature infants. Four patients seen early in this series required revision of the position of the pleural catheter, with successful drainage in each instance. Pleuroperitoneal shunting is a safe, simple, and effective treatment of chylothorax in infants and children. In view of our success in treating chylothorax with these shunts, we recommend early shunting before the development of nutritional or immunological depletion. Contact the hospital OK. Wish your family all the best.

Question: Fluid in cats lungs? Chylothorax in Cat? What are the signs of it, other than the clinical signs? Like what have you noticed at home, does the cat act different and how? My cat acts like she tries to cough up a fur ball but she never does. she has these sort of attacks 3-4 times a day that I've noticed. and ive listended to her breathing up close when she has them and it sounds like she has fluid in her lungs and she weases alot. is this something anyone has experience with their cats. I'm calling the vet on monday to get x-rays and other tests if necessary.

Answer: Fluid in the lungs is a very serious and life-threatening problem, especially if you can hear it without a stethoscope. I agree with you that x-rays are in order. your vet can help you with a treatment plan - it usually includes Salix, a diuretic to help rid the body of excess fluid. Sometimes the fluid goes unnoticed - just a couple months ago we had a cat come in for a neuter, did ECG and bloodwork and all that good stuff, knocked him out, did the neuter, he started waking up, and then he stopped breathing and his heart stopped beating - got it started again with trusty ol' epinephrine, took x-rays, he had not only fluid in his lungs, but also a very enlarged heart with fluid buildup around it. When we were finally able to pull the trach tube, it was covered in mucous. When he "woke up" he was out of it, as if he couldn't see or anything, like brain damage. He died overnight 2 days later. However, on a brighter note, it may just be hairballs, and a little CatLaX, hairball prep, or something similar will do the trick. But I'd rather be safe than sorry. I think you're taking the appropriate action in getting rads. taken. I'd also do an ECG and bloodwork., but your vet can help you determine what all is needed.

Question: Chylothorax??? Help needed? My son has just has a heart op, but the nicked his lymph gland now he has what they call a chloyhorax and he is only allowed to eat 3 grams of fat a day for 6 weeks, till it heals up. And i was just wondering if anyone else knows or experienced it as i could really do with some savoury food ideas. All the dietitians gave me were sweet foods and my son is only 3 and don't want him having too much sugar. Thanks

Answer: Sometimes in heart or chest surgery, a lymph vessel can be injured by surgical instruments. A chylothorax is the build up of a milky white fluid, in the space surrounding the lungs. This makes it difficult to breathe. Basically, the lungs are surrounded by several layers of a protective lining called the pleura surround the lungs. Fluids can collect between the pleura layers (called the pleural space). A chylothorax happens when the lymphatic system starts leaking chyle fluid into the pleural space. The fluid pushes on the lung, making it hard to breathe. The special diet your child has been put on will decrease the amount of chyle thats produced and promote healing. This diet is called a medium chain triglyceride (MCT) diet. Don't worry to much about the sugar content, usually, children who have this complication don’t have to stay on this diet for long. It won't do any harm, include plenty of fruit. Foods included in the diet are fruits, vegetables, pasta, skim milk, and plain bread (no nuts, fried breads or fatty breads like doughnuts or croissants) Your son must not eat meat, egg yolks, cheese, milk products and desserts with a high fat content.

Question: Is feline chlothorax fatal? My male cat has been diagnosed with chylothorax. Is there a chance that he will live? Is it treatable? is there a cure?

Answer: The current prognosis for cats with chylothorax is usually described as guarded to poor. The disease remains complicated with a poorly understood etiology. More research is certainly needed to better comprehend the pathophysiology and most beneficial treatment of this disease. You will need to discuss options with your vet to decide what is best for you pet and if treatment is an option. Best of luck to you and your pet.