Chronic Chylothorax in Childhood: Clinical Complexity and Management Challenges—A Case Report and Literature Overview

Background and Clinical Significance: Pleural effusion results from an imbalance between fluid production and lymphatic drainage within the pleural space and may arise from a wide range of conditions. Chylothorax, characterized by the accumulation of chyle in the pleural cavity, is an uncommon cause of pleural effusion in the pediatric population. Although octreotide has been widely used in neonatal postoperative chylothorax, evidence supporting its role in acquired chylothorax beyond infancy remains limited, and dosing strategies are not standardized. This report describes the management of massive chylothorax in an adolescent patient. Case Presentation: A 13-year-old girl presented with fatigue, decreased exercise tolerance, vertigo, and diaphoresis and was diagnosed with massive right-sided chylothorax based on imaging and pleural fluid analysis. Treatment consisted of pleural drainage, dietary measures, and continuous intravenous octreotide administered within a multidisciplinary care framework. Chylous drainage declined progressively, with complete resolution of the effusion achieved without surgical intervention. Conclusions: Chylothorax in older children and adolescents may present with nonspecific symptoms and requires a high index of clinical suspicion. Early diagnosis, appropriate drainage, and individualized therapy are essential for favorable outcomes. Continuous octreotide infusion may represent an effective adjunctive treatment in selected pediatric cases, but further studies are needed to define optimal dosing and treatment duration.