Abstract Chylothorax accounts for approximately 3% of all pleural effusions, diagnosis of chylothorax is confirmed by elevated triglyceride levels ( 110 mg/dL) and the presence of chylomicrons in the pleural fluid analysis. Etiology of chylothorax can be largely separated into two categories, traumatic (risk in most thoracic surgeries) and non-traumatic (malignant, overload, drug induced, infection or idiopathic) causes. As chyle plays a valuable role in regulating the immunity and nutrition in our body it is important to effectively manage this condition. While surgical treatment is effective most of the time in traumatic cases the treatment outcomes for non-traumatic cases remains sub-standard. We present a case of an unrelenting non-traumatic chylothorax managed with Midodrine.A 66-year-old caucasian male with past medical history of high output heart failure of unclear etiology, chronic myeloid leukemia on Dasatinib for a year prior to presentation, stage 3a chronic kidney disease presented to our hospital with fluid overload and bilateral pleural effusions. He underwent right heart catheterization which showed elevated pulmonary wedge pressure. The patient was diuresed without any improvement in his bilateral pleural effusions. The patient eventually underwent bilateral thoracentesis which showed “milky” appearing pleural fluid with triglyceride levels of 296 and 140 on left and right side respectively. Dasatinib was initially thought to be the culprit and thus the mediation was discontinued. The patient had a recurrence of symptoms along with his pleural effusions needing repeated thoracentesis showing persistent chylothorax in the out-patient setting. Further work up including repeat computed tomography of chest, flow cytometry and magnetic resonance imaging thoracic duct protocol were also negative for any etiology. During all this time the patient was continually diuresed along with dietary changes to reduce the intake of triglyceride rich foods. Given recurrent symptoms a decision was made to start the patient on Midodrine 10mg three times a day and he was referred to see interventional radiology and thoracic surgery for further management. By the time the patient saw the thoracic surgeon his symptoms had significantly improved and his chest X-ray showed near resolution of his bilateral pleural effusions. The patient has been on Midodrine now for more than one year with good control of his symptoms. While surgical management and dietary changes remain the frontline management options in most cases, Midodrine and other alpha agonists appear to be a promising alternative in difficult to manage chylothorax via lymphatic vasoconstriction. This abstract is funded by: None
Marandola et al. (Fri,) studied this question.