DOI: 10.12890/2024_004705

Utility of an alpha-1 adrenergic agonist in the management of chylothorax: a case series and management algorithm

Authors

  • Ruben Peralta Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha, Qatar; Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
  • Ahmed F. Ramzee Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
  • Zeenat Khuda Bakhsh Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
  • Ayman El-Menyar Department of Surgery, Clinical Research, Trauma & Vascular Surgery, HMC, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
  • Ahmed Ajaj Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
  • Hassan Al-Thani Department of Surgery, Trauma Surgery, Hamad Medical Corporation (HMC), Doha, Qatar

aymanco65@yahoo.com

Keywords

Chylothorax, α1-adrenergic agonist, chest, octreotide, algorithm

Abstract

Chylothorax is the accumulation of lymphatic fluid (chyle) within the pleural space. There are multiple causes, including traumatic and non-traumatic mechanisms. Trauma can cause disruption of the thoracic duct either by direct damage or indirect crushing or avulsion mechanisms. Non-traumatic causes include infections, inflammatory processes, malignancies, and iatrogenic injury (during surgery or central venous access). The traditional management of traumatic chylothorax has been either a conservative approach, including complete nil per os, or a low-fat diet with medium-chain triglyceride supplementation with the administration of somatostatin or its analog, octreotide, versus a surgical approach consisting of thoracic duct ligation. Recently a less invasive approach via thoracic duct embolization has gained popularity. There have been a few reports of the successful use of an alpha 1-adrenergic agonist (midodrine) as an adjunct in the conservative approach. We describe the utility of midodrine in three cases of chylothorax and propose a management algorithm.

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References

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Published

2024-07-29

Issue

Vol. 11 No. 8 (2024)

Categories

How to Cite

1.
Peralta R, Ramzee AF, Bakhsh ZK, El-Menyar A, Ajaj A, Al-Thani H. Utility of an alpha-1 adrenergic agonist in the management of chylothorax: a case series and management algorithm. EJCRIM [Internet]. 2024 Jul. 29 [cited 2026 Nov. 4];11(8). Available from: https://ejcrim.com/index.php/ejcrim/article/view/4705

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