Successful treatment of late-onset chylothorax with low-fat diet and octreotide after pulmonary resection for lung cancer

Abstract

The patient was a 74-year-old woman who underwent right upper lobectomy and mediastinal dissection for lung adenocarcinoma pT1bN0M0, stage IA. Her postoperative recovery was uneventful. Two months after surgery, she presented with a large right pleural effusion on chest radiograph and chest computed tomography. The triacylglycerol level in pleural fluid was >110 mg/dL; thus, she was diagnosed with late-onset chylothorax. Her general condition was stable, and she was therefore managed conservatively with a chest drainage tube, fasting, and octreotide administration. Three days after the start of chest drainag, the pleural fluid level rapidly began to decline; she was thus given a low-fat diet. As she was underweight, we increased her fat intake and gradually decreased the octreotide dose. On day 11 of chest drainage, the pleural effusion had resolved and we removed the tube. She did not experience pleural effusion recurrence after drainage tube removal. She was discharged on day 15, and has not shown chylothorax recurrence during the 1-year follow-up.

The cause of late-onset chylothorax remains unknown. However, a low-fat diet was less burdensome than fasting; her general condition was stable, and the chylothorax was managed conservatively.