Clinical outcomes of non-traumatic chylothorax at a Singapore tertiary referral hospital.

BACKGROUND AND

OBJECTIVE

While the management of traumatic chylothorax has advanced over the past two decades, outcomes for non-traumatic chylothorax remain poor, with a paucity of data to guide management and prognostication.

METHODS

We performed a retrospective analysis of patients diagnosed with chylothorax between January 2020 and December 2024. Clinical data including interventions and clinical outcomes were recorded.

RESULTS

We evaluated 40 patients with a median age of 61 (IQR: 50-72) years. Cancer was the most common cause (67.5%), of which 18 (45%) patients had solid-organ malignancies and 9 (22.5%) had haematological malignancies. Other aetiologies included drug-induced (10%) and liver cirrhosis (7.5%). Despite dietary measures implemented in 65.0% of patients, 52.5% of patients required ≥2 pleural interventions, with chest drain and indwelling pleural catheter insertions performed in 32 (80.0%) and 8 (20.0%) patients, respectively. Lymphatic imaging was infrequently (20.0%) performed, with chyle leak identified in only one patient. The 90-day and 1-year mortality was 37.5% and 55.0%, respectively, with the highest 1-year mortality rates seen with solid organ cancers (83.3%) and liver cirrhosis (66.7%). Eighteen (45.0%) patients had clinical resolution of chylothorax, and this was highest in patients with drug-induced chylothorax (100.0%) followed by patients with haematological malignancies (66.7%).

CONCLUSION

Non-traumatic chylothorax secondary to haematological malignancies and drugs have more favourable outcomes compared with solid organ cancers and liver cirrhosis. This highlights the need for a personalised and multidisciplinary approach to the management of chylothorax.