Tension chylothorax caused by occult trauma

Isolated thoracic duct injury from blunt force trauma

Isolated thoracic duct injury is an uncommon clinical event and is rare in the setting of trauma. We describe a case of an isolated thoracic duct injury resulting in the development of bilateral chylothorax following a motor vehicle collision in the absence of any other definable injury. We outline the initial patient presentation and diagnosis. After failing a trial of conservative management the patient underwent lymphangiography followed by thoracic duct ligation with pleurodesis. This case highlights the importance of recognizing thoracic duct injury following trauma.

Traumatic tension chylothorax: Lessons from a rare complication of thoracic spinal trauma

Injury to the thoracic duct following blunt trauma can rarely result in tension chylothorax. We report a case of traumatic tension chylothorax in a young man with cervical and thoracic spine injuries after he was hit by the open luggage compartment of a passing bus. Diagnosis was made on the fourth day following injury when he became short of breath during physiotherapy, and then deteriorated rapidly with haemodynamic compromise. The tension chylothorax was treated with intercostal drainage leading to immediate resolution of cardiorespiratory function. No further surgical intervention was required. This case highlights three important learning points: pleural fluid, not just air, can cause tension; seriously injured patients should have a multidisciplinary trauma team assessment on arrival to hospital and when reviewing radiographs, all the structures should be carefully examined, not just those that the study was performed to examine.

Tension chylothorax in two pediatric patients

Although the accumulation of gas is the most common cause of an expanding interpleural space, the presence of other structures or substances (hydrothorax, gastrothorax, hemothorax, urohemothorax, pyothorax, and chylothorax) under pressure may be sufficient to cause hemodynamic and respiratory compromise. We present two pediatric patients that developed hemodynamic and respiratory effects secondary to a chylothorax. The first patient presented in respiratory distress and cardiovascular collapse 4 weeks after a Fontan procedure. Placement of a chest tube resulted in the release of chyle under pressure and prompt resolution of hemodynamic and respiratory symptoms. The second patient was a 2100 g neonate who developed a chylothorax during an episode of sepsis following gastroschisis repair. On two separate occasions, the development of the chylothorax was associated with tachycardia, oliguria, and increased requirements during mechanical ventilation. Chest tube placement resulted in the release of chyle under pressure and resolution of the symptoms. These two cases demonstrate that chylothorax like pneumothorax can have deleterious effects on hemodynamic and respiratory function.