CLINICAL CASES   

Minerva Chirurgica 2006 April;61(2):155-8

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Use of octreotide, a long-acting somatostatin analogue, in the treatment of chylothorax of idiopathic etiology

Chen-Scarabelli C., Amà R., Abboud J., Jabarren M., Saravolatz L., Scarabelli T. M.

¹ Division of Cardiology VA Medical Center University of Michigan, Ann Arbor, MI, USA 2 Center for Heart and Vessel Preclinical Studies Division of Cardiology St. John Hospital and Medical CenterWayne State University, Detroit, MI, USA

We describe a case of chylothorax of idiopathic etiology, treated with octreotide, a long-acting somatostatin analogue. A 30-year-old man with a left supraclavicular mass, and chylothorax, initially diagnosed by outpatient thoracentesis, underwent diagnostic surgery to ascertain the etiology of the pleural effusion. Biopsies of the left supraclavicular mass, lymphatic tissue and lymph nodes were benign. Triglyceride level in the pleural fluid was 396 mg/dL, diagnostic of chylothorax. Treatment included intravenous total parenteral nutrition (TPN) and a nil per os (NPO) diet. Subsequent surgical interventions included left lung decortication and glue-mediated control of chylothorax, combined with TPN and a strict low-fat diet. Given the persistency of chylothorax, thoracic duct ligation was also performed, and octreotide subcutaneous injections were started, with dramatic resolution of pleural effusion, after 1 week of treatment, in absence of any side effects. The patient fully recovered, and no relapse has been observed during a follow-up period of over 1 year. In conclusion, octreotide showed to be a valid and safe noninvasive approach for the treatment of chylothorax, whose early clinical use may also reduce the need for surgical intervention.