Idiopathischer Chylothorax bei Hund und Katze

Zusammenfassung

Der idiopathische Chylothorax ist eine seltene Erkrankung beim Kleintier mit weitgehend unklarer Ätiologie. Beim Hund konnten mittlerweile in mehreren Studien hohe Erfolgsraten nach chirurgischer Behandlung erzielt werden, die Prognose bei der Katze bleibt dagegen weiterhin ungünstig. Ziel dieses Artikels ist es, ein integratives Verständnis der Erkrankung zu entwickeln, das anatomische, pathophysiologische, physikalische und klinische Aspekte systematisch verknüpft. Die verfügbaren konservativen und chirurgischen Verfahren werden im Hinblick auf Erfolgsraten, Komplikationen und prognostische Relevanz eingeordnet. Dabei wird herausgearbeitet, welche therapeutischen Entscheidungen sich trotz begrenzter Datenlage in der Praxis begründen lassen – und welche Annahmen kritisch zu hinterfragen sind. So erscheint insbesondere ein verzögerter Operationszeitpunkt als potenziell nachteiliger Aspekt im derzeitigen Behandlungskonzept. Auch die bislang standardisierte Wahl einer weit kaudalen Ligatur des Ductus thoracicus wird im Licht anatomisch-pathophysiologischer Kenntnisse diskutiert. Die derzeitige Studienlage erlaubt zudem keine klare Indikationsstellung für eine Ablation der Cisterna chyli; auch zur Rolle der Perikardektomie bestehen in der neueren Literatur unterschiedliche Einschätzungen. Aus den dargestellten Beobachtungen ergeben sich konkrete Impulse für weiterführende Forschung und eine differenziertere klinische Entscheidungsfindung.

Abstract

Idiopathic chylothorax is a rare condition in small animals with a largely unknown etiology. In dogs, several recent studies have reported high surgical success rates, whereas the prognosis in cats remains unfavorable. The aim of this article is to develop an integrative understanding of the disease by systematically integrating anatomical, pathophysiological, physical, and clinical perspectives. Available conservative and surgical treatment strategies are evaluated with regard to success rates, complications, and prognostic relevance. Particular emphasis is placed on identifying which therapeutic decisions can be reasonably supported in clinical practice despite limited evidence and which prevailing assumptions warrant critical reassessment. A delayed surgical approach, in particular, appears to represent a potential negative aspect in current treatment concepts. The commonly standardized practice of performing thoracic duct ligation at a caudal thoracic level is also reconsidered in light of anatomical and pathophysiological findings. Furthermore, the current literature provides no clear recommendation regarding the indication for cisterna chyli ablation, and there is increasing divergence of opinion on the role of pericardectomy. The insights presented here generate concrete impulses for further research and support a more differentiated basis for clinical decision-making.

Schlüsselwörter

Kleintier - Ductus thoracicus - Cisterna chyli - Perikardektomie - Pathophysiologie - Chirurgische Therapie

Keywords

Small animal - thoracic duct - cisterna chyli - pericardectomy - pathophysiology - surgical treatment

Publication History

Received: 27 May 2025

Accepted: 24 October 2025

Article published online:
28 November 2025

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