Resolution of Persistent Chylothorax With a Ketogenic Diet: A Case Report

This is the first case report of a very low-carbohydrate, high-fat ketogenic diet for the treatment of chylothorax. A 61-year-old female with recurrent chylothorax following thoracic surgery was refractory to a very low-fat diet managed by a hospital dietitian. She required repeated palliative thoracentesis to the point where she was scheduled for a thoracic duct embolization. Prior to the embolization, she was placed on a very low-carbohydrate (<20 total grams daily), high-fat, ketogenic diet. Metabolic markers and imaging were obtained regularly. The patient had improvements in her serum triglycerides, triglyceride/HDL ratio, and triglyceride-glucose index, as well as clinical and radiographic improvements in her chylothorax as assessed by a chest X-ray and CT scan. Within three months of starting her ketogenic diet, imaging revealed complete resolution of the chylous pleural effusion. This case suggests that metabolic optimization to decrease insulin resistance, improve chylomicron metabolism, decrease lymphatic permeability, and lower serum triglycerides, as occurs with a ketogenic diet, should be considered for conservative treatment of chylothorax and warrants further study.