Chylothorax: therapeutic alternatives.

Persistent loss of chyle, rich in metabolites, water and electrolytes, can be quickly devastating, particularly in debilitated patients and children. Chylothorax of traumatic origin, especially when loss of chyle is rapid, is most effectively arrested with direct closure of the fistula or ligation of the thoracic duct. Thoracic duct ligation is indicated when a controlled fat diet or parenteral hyperalimentation without oral intake and closed chest drainage are not effective in arresting chylous pleural effusions.