Managing chylothorax requires the evacuation of fluid from the thorax. This can be done through intermittent thoracentesis or with a tube which is placed in your pet’s chest area. The tube method means your pet will need to be kept in hospital. The purpose of removing the chyle is to improve the expansion of the lungs which will result in improved breathing and less coughing. Thus, your pet will be more comfortable. It will be recommended that your pet is put on a low-fat diet which aims to reduce the number of chyle flowing through the thoracic duct. However, research has showed that the diet alone is not enough to reduce the chyle running through the thoracic duct. The over-the-counter medication called rutin is sometimes helpful in cases of idiopathic chylothorax. The medication is believed to stimulate protein break down and removal through the lymphatic vessels. How effective rutin is, has not yet been effectively proven.
Medical management of idiopathic chylothorax is rarely successful. The next option is then surgical intervention. As mentioned before, your pet can potentially have a compromised metabolism if the lack of chyle in the thoracic cavity is prolonged. If there is inflammation in the lungs caused by chronic chyle exposure, there is less of a chance that your pet will recover. If the treatment required for your pet’s case of chylothorax is surgery, it is recommended that you ask to be referred to a board-certified veterinarian.
The most common surgical process for treating chylothorax is called thoracic duct ligation (TDL). This procedure aims to promote abdominal lymphatic connections through the prevention of chyle into the TD. Ultimately, the goal will be to prevent chyle leakage through the TD into the thoracic cavity. The success rates have recently been improved by combining TDL with removing the heart lining, known as pericardiectomy. There will also be a tube placed in the chest which will allow aspiration post-operation. Some vets will opt to also perform abdominal surgery. This will allow vets to confirm the success of TDL after surgery.
Another promising treatment of chylothorax is the cisterna chyli removal (CCA). Cisterna chyli is found in the abdomen and it acts as a lymphatic fluid reservoir. CCA will destroy the reservoir in order to promote the creation of new pathways for the lymphatic fluid, essentially relieving the TD of pressure.
Another option, instead of surgery, is a less invasive alternative called video-assisted thoracoscopy. It is often used to perform TDL, CCA and pericardiectomy on dogs. It can be a better option as it is said to be significantly less invasive, reduce the time taken for lymphangiography to be completed and also remove the need of abdominal surgery.
Having your pet go for surgery has potential risks. It is also time consuming. Some of the complications associated with surgery are haemorrhage, nerve damage of the diaphragm, infection and continuous fluid accumulation in the chest.