ACR Appropriateness Criteria® Management of Chylothorax.J Am Coll Radiol 2026 Mar 06. [Online ahead of print]JA
Chylothorax, the accumulation of lymphatic fluid within the pleural cavity, results from disruption or obstruction of the thoracic duct or its tributaries, or from transdiaphragmatic chylous ascites. When severe, this condition may impair respiratory function and induce metabolic complications because of chronic loss of protein and lipids. Management strategies ranging from dietary modifications, medical therapy, surgical ligation, pleurodesis, and lymphatic embolization, generally follow a tiered approach. Special considerations apply to chylothorax associated with central venous obstruction or concurrent chylous ascites, sometimes requiring unique management strategies. The various approaches to the management of chylothorax and their appropriateness in a variety of clinical circumstances are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
