Arunabh M.D.; Fein, Alan M. M.D., F.A.C.P.Clinical Pulmonary Medicine: March 1997 Topics in Pulmonary Medicine: PDF Only Buy Abstract Chylothorax is a collection of chyle in the pleural space, resulting from disruption of the thoracic duct. It most commonly results from trauma or malignancy. The optimal management of chylo-thorax depends on the basic causative factor, anatomy of the thoracic duct, and magnitude of chyle and protein loss. Initial conservative therapy includes intercostal decompression of the pleural effusion along with nutritional support in the form of total parenteral nutrition. Surgical intervention includes thoracic duct ligation or pleuroperitoneal shunt, and the decision depends on the underlying pathogenesis. Ligation of the thoracic duct is usually performed for traumatic disruption of the duct and can be accomplished via open thoracotomy, abdominal approach, posterior extrapleural approach, or through video-assisted thoracos-copy. Pleuroperitoneal shunt is usually performed for nontrau-matic chylothorax. Pleurodesis is considered for resistant chylothorax secondary to malignant disease. © Williams & Wilkins 1997. All Rights Reserved.