Imaging

Chylothorax

Preliminary Diagnosis: Chylothorax

I. What imaging technique is first-line for this diagnosis?

  • Plain radiographs

II. Describe the advantages and disadvantages of this technique for diagnosis of chylothorax.

Advantages

  • Sensitive for a pleural effusion often found on the left side

  • Quick

  • Inexpensive

  • Minimal exposure to ionizing radiation

Disadvantage

  • Cannot assess contents of pleural fluid or quality of the fluid just on radiographs

III. What are the contraindications for the first-line imaging technique?

Relative contraindication during pregnancy. A consent may be required before proceeding at some institutions.

IV. What alternative imaging techniques are available?

  • CT of the chest

  • Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of chylothorax.

CT of the chest

Advantages

  • May identify underlying etiology, such as mass or congenital anomaly

  • May identify associated complications such as loculated fluid and parenchymal lung disease

Disadvantages

  • Need additional procedure to confirm that the pleural effusion is chylous

  • Exposure to ionizing radiation

Ultrasound

Advantage

  • Can appreciate an effusion usually without debris or septations

Disadvantages

  • Need additional procedure to confirm that the pleural effusion is chylous

  • This imaging is operator dependent.

  • Requires some patient cooperation

VI. What are the contraindications for the alternative imaging techniques?

CT of the chest

Relative contraindication includes pregnancy

Ultrasound

No significant contraindications

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