What is Chylothorax?
This condition is often characterised by the inability of the patient to fully inflate their lung due to the buildup of fluid in the thorax. This buildup can lead to inflammation of the lungs and heart. Due to the potential for long-lasting harm, it is essential that your dog receives prompt treatment if you suspect they may be suffering from this condition.
Chylothorax is an uncommon, poorly understood disease in which chyle accumulates in the thoracic cavity. This may be caused by underlying heart conditions, trauma, cancer, fungal disease or blood clots; however, often the cause is idiopathic.
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Symptoms of Chylothorax in Dogs
The symptoms displayed in a pet suffering from chylothorax are commonly seen in other respiratory illnesses such as pneumothorax. Signs may include:
- Non-productive cough
- Appetite reduction or weight loss in chronic cases
- Breathing difficulties
When left untreated this condition can cause irritation, inflammation and irreversible damage to the lungs and pericardium.
Causes of Chylothorax in Dogs
Chylothorax is caused by the buildup of the fluid chyle, which is lymphatic fluid, in the thoracic cavity. In a normally functioning canine, chylomicrons are produced following the ingestion of fats, these molecules are absorbed in the cisterna chyli and carried through the thoracic duct to the cranial vena cava. In canines suffering from chylothorax, a dysfunction in the thoracic duct leads to leaking of chyle into the thorax. This can result in difficulty breathing due to reduced lung inflation, weakened immune system, and metabolic disorders. There are many diseases that may cause this dysfunction such as cancer, fungal disease, and heart conditions such as murmurs and blood clots.
Diagnosis of Chylothorax in Dogs
Your veterinarian will perform a full clinical examination. Signs that may indicate fluid in the thoracic cavity are muffled heart or lung sounds on auscultation. If your veterinarian suspects fluid in the thorax radiographs of the thoracic area may be performed. Your veterinarian may be able to visualise fluid in the thorax from the radiograph, allowing a diagnosis of pleural effusion to be made; however, she will not be able to confirm the presence of chyle. In order to determine the type of fluid present in the chest your veterinarian will likely perform a thoracentesis. In order to carry out this procedure sedation may be necessary for your pet. This procedure is performed by the veterinarian inserting a small needle between your dog’s ribs into the thoracic cavity and aspirating in order to obtain fluid. Through visual examination your veterinarian may suspect chylothorax due to the distinct, milky appearance. In addition, it may be sent for laboratory testing for confirmation.
As chylothorax can be a secondary complication of underlying conditions further diagnostics such as thoracic or cardiac ultrasound or computed tomographic scans may be performed.
Treatment of Chylothorax in Dogs
Your veterinarian will initially focus on trying to remove the chyle from the thoracic cavity of your pet in order to allow your companion to breath with full lung expansion. This may require a tube placed into the thorax or or intermittent thoracentesis.
Your veterinarian may feel that thoracentesis will not be an effective treatment for your pet and choose to perform surgery to treat this disease. The two surgical options are:
Thoracic duct ligation – This surgical method involves the ligation of the thoracic duct, preventing the chyle flow through this duct and instead forcing the body to develop new lymphatic connections to the venous system in the abdomen.
Ablation of the cisterna chyli – This surgical method involves removing the cisterna chyli, causing the body to create new pathways for the lymph fluid to enter the bloodstream, allowing pressure on the thoracic duct to be relieved, and leaking of chyle into the thorax reduced.
Recent studies have also shown that a pericardiectomy, the removal of the pericardium, may be beneficial in treatment of this condition. Your veterinarian will discuss with you the risks involved with this procedure. The surgery for chylothorax may be time consuming and due to decreased lung capacity and the respiratory effects of anesthesia agents, your dog is at an increased anesthetic risk.
Recovery of Chylothorax in Dogs
Your dog will likely require hospitalization following the surgery. As anesthetic can cause hypothermia and excitement during the recovery period he will be provided with a warm, quiet environment during the postoperative period, in some cases oxygen therapy may also be indicated during this time. Your veterinarian may continue to drain your pet’s thorax intermittently using the chest tube. Your dog will be carefully monitored and once his chest tube is able to be removed he will be able to be discharged.
Offer regular, palatable meals and encourage food intake during your pet’s recovery. A diet restrictive of fat may be indicated by your veterinarian.
Regular revisit appointments are vital and intermittent, outpatient thoracentesis may be necessary if clinical signs present. The prognosis varies depending on the treatment given, however when successful you can expect full recovery within a few weeks of surgery.
Chylothorax Questions and Advice from Veterinary Professionals
My dog fell down a 10 ft well and came into contact with some unknown caustic substance. she sustained a puncture wound to her back, r. leg which required amp of two toes. It's healing but final status TBD. as she was getting ready for discharge she presented w/a chylothorax that required they evacuate 3500 mls of fluid. currently shes in the doggie ICU w/bilateral chest tubes, IJ catheter. We're on day 15 and no significant improvement. They added steroids to her care yesterday. They assume the condition is secondary to trauma but really there unsure. I don't know what to do and frankly I'm exhausting my financial resources. They keep telling me she's a mystery of sorts. But that is unhelpful in helping my baby.
Chylothorax is not really understood well in small animals and trauma is often a contributing factor for the accumulation of chyle in the thorax. Drainage of chyle from the thorax is an initial step, but thoracic duct ligation may need to be performed and movement to a low fat diet. I unfortunately cannot shed more light on this. Regards Dr Callum Turner DVM
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My GSD had the thoracic duct ligation and pericardectomy surgery done nearly 7 years ago and is still going strong. My question is, does she have to be on a very low fat diet the rest of her life? She has had no complications thus far but I cannot get a straight answer from the specialty center or her regular vet. They both tell me it "wouldn't hurt to keep her on it".
The reason I ask this now is because I lost my other GSD very suddenly in February and since then Daisy hasn't eaten the same and has lost nearly 10#. I have done a full work-up on her to make sure there was nothing else going on with her. I switched her from Blue Buffalo Healthy Weight (she was on this her entire life) to Nutro Wholesome Essentials Healthy Weight. Since switching her, she has started to eat a little better but her stools are starting to become loose. I am finding it difficult to find another low fat diet in the same price range that isn't full of fillers, so if I could cut out the low fat portion (especially because she has lost weight) that would really help in the search.
A low fat diet is recommended to reduce the flow of chyle through the thoracic duct, if the thoracic duct has been ligated there should be no more flow of chyle. The problem with chylothorax is that we know very little about this condition and there is little reputable scientific evidence of different treatments which leads Veterinarians now wanting to commit to an answer on some questions. You could try moving to another diet which may have more fat but still less in relation to other products on the market. Some over the counter supplements like rutin are reported to help but again there is no scientific evidence published. Regards Dr Callum Turner DVM
My dog was diagnosed with chylothorax almost 6 months ago, there isn't a surgeon in Oklahoma that my vet would trust with surgery so I haven't done the surgery and she said there is only a 50% chance of the surgery working. I take Bart in about once a month to get his chest drained. He is on satiety control from royal canin (he was on the GI low fat one but actually put on weight because he liked the food so much). He takes 3000mg of rutin three times a day, spironolactone 50mg three times a day, and 5mg of prednisone once a day.
I was wondering what happened with your pincher as my Australian Sheperd has the fluid in the chest and abdomin as well. She had surgery a week ago and during the follow up today, she has fluid build up in her stomach, but her chest seems clear. Have you had any success?
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My dog has been diagnosed with Chylothorax. We had the pleural port inserted. The first time fluid was drained it was 3-4L. He is a large black lab. At Cornell when they inserted the port they pulled another 1/2l. He is being treated with Octreotide 3x daily and the low fat diet and rutin. My question which has been not answered is what is our life expectancy?
The underlying cause of the chylothorax would have a bearing on the prognosis; the buildup of chyle in the thorax may be caused by infections, tumours, blood vessel disorders or idiopathic in nature (unknown). Without knowing the underlying cause, I could attempt a prognosis; also if a prognosis was known, they would have been able to give you an indication at Cornell. Regards Dr Callum Turner DVM
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What is the best diet for dog that has been sensitive to grains? He has been diagnosed with chylothorax. Do you have a brand name
If you have a dog sensitive to grains (diagnosed by a Veterinarian) then there are a few different diets available including Hill’s Science Diet Adult Grain Free Dog Food and Royal Canin Hydrolyzed Protein Adult HP Dry Dog Food; there are many other grain free diets which maybe available depending on your location. Regards Dr Callum Turner DVM
I have a 12 1/2 year old Malinois just diagnosed with chylothorax. He's already a lean dog and picky eater so finding an affordable dry food that he'd eat was important. I found two brands. Earthborn Holistic grain free weight control and Annamaet Lean grain free reduced fat formula. Both met the vet's recommendations for being ultra low fat diets and if I soak it with hot water first, he eats all of it. Both can be ordered online at Chewy.com
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