An idiopathic congenital chylothorax: surgery or conservative management?

A 3-month-old infant was admitted to the respiratory unit for dyspnoea and vomiting after her second DTaP-Polio vaccine shot. The chest X-rays showed a white right lung with a left mediastinal shift. A pleural aspiration assessed the diagnosis of chylothorax. A conservative treatment was initiated with a fat-free diet and pleural aspirations. As this treatment was ineffective, a total parenteral nutrition was started at day 11, plus increasing doses of Octreotide. As the chylothorax persisted at day 50, a pleuroperitoneal shunting was performed but a pleurodesis was finally necessary. The child was discharged from the hospital 6 weeks after the surgery. Ten months later, her physical and biological conditions were normal and her chest X-rays dramatically improved. This case highlights the difficult management of infant chylothorax. Although conservative treatment has to be tried first, surgical procedures as pleuroperitoneal shunting and rarely pleurodesis have to be discussed.