ECMO-/ECLS

from compressive or acceleration-deceleration forces. Although traumatic
chylothorax in children has been described after motor vehicle crashes, it is
also seen after child abuse.
Traumatic chylothorax usually has a cryptogenic and sometimes delayed
presentation, because the development of a clinically significant chylous
effusion may take up to 24 hours to accumulate. In the acute setting of trauma,
clinical examination may be similar to pleural injury or hemothorax, with findings
of respiratory distress or diminished breath sounds on auscultation.
Regardless, evaluation remains unchanged, as these findings should prompt
further evaluation with a chest x-ray.
The identification of a pleural effusion in the acute setting of trauma is a
hemothorax, until proven otherwise. Consequently, a tube thoracostomy
should be placed to drain the affected side. Diagnosis of a chylothorax is
established with the evacuation of milky-white pleural fluid. Fluid analysis
demonstrating triglycerides levels > 110 mg/dL, lymphocytes > 1000cells/mL,
presences of chylomicrons, and low cholesterol levels is confirmatory. Due to
its association with non-accidental trauma, further evaluation of the child is
necessary for concomitant injuries.
Chylothorax can result in respiratory, nutritional, and immunologic
compromise, due to losses in the pleural space. Management includes chest
tube decompression, dietary modification, and nutritional support. The primary
goal of therapy is to decrease chyle flow to allow closure of the disrupted
thoracic duct. The patient may be trialed on a low-fat diet consisting of only