Chyle


Chyle is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids. It is formed in the small intestine during digestion of fatty foods, and taken up by lymph vessels specifically known as lacteals. The lipids in the chyle are colloidally suspended in chylomicrons.

Clinical significance

A chyle fistula occurs when defect of lymphatic vessel result in leakage of lymphatic fluid, typically accumulating in the thoracic or abdominal cavities, leading to a chylous pleural effusion or chylous ascites, respectively.
Diagnosis of a chyle fistula may be accomplished by analysis of pleural/peritoneal fluid. Identifying the source is often challenging, but may be accomplished with lymphangiography, which is occasionally associated with a serendipitous therapeutic effect, thought to be secondary to a sclerosant effect of the lymphangiography contrast.
Due to the extreme friability of the lymphatic vessels, direct repair of defects is impractical. Therefore, treatment of chyle fistulae relies upon either decreased production of lymphatic fluid to allow for healing of lymphatic defect or permanent diversion of lymphatic fluid away from lymphatic defect. Decreased production of lymphatic fluid may be accomplished by dietary restriction, as well as by the medications octreotide and orlistat. Permanent diversion of lymphatic fluid may be accomplished by thoracic duct embolization or by thoracic duct ligation.