Late presentation of tension chylothorax following blunt chest trauma

Chylothorax caused by blunt chest trauma: a review of literature

Chylothorax is the accumulation of chyle in the pleural cavity that typically contains a high concentration of triglycerides. Blunt chest trauma is a rare cause. The aim of this study is to review all of the reported cases of chylothorax caused by blunt chest trauma. Available databases were explored systematically for the condition and the eligible papers were included. The literature search revealed 30 studies with 39 cases, 72.3% of the cases were male, and 21.7% of the patients were female. The age range varied between 4 and 75 years with a mean age of 35.8 years. All of the patients were diagnosed after fluid sampling from the pleural fluid by thoracentesis and/or chest tube insertion. About 71.4% of the patients were treated successfully by conservative management: others (28.6%) were managed surgically. Although it is a rare condition, persistent milky drainage after blunt chest trauma should raise the suspicion of chylothorax. Pleural fluid sampling is the cornerstone of the diagnosis. In the majority of the cases, conservative treatment is quite enough. Surgery is indicated whenever non-operative measures failed.

Massive bilateral chylothorax post blunt trauma

Chylothorax caused by blunt trauma is extremely rare. We present a case of bilateral massive chylothorax post blunt trauma and a review of the literature regarding the identification and management of this rare diagnosis. An eighteen-year-old male was involved in a motor vehicle crash where he sustained multiple injuries including a right, moderate to large, haemopneumothorax, a small left haemopneumothorax, left T8, T9, L1 and L2 acute transverse process fractures and fractures of bilateral 11th ribs. An intercostal catheter was inserted on the right side which initially drained blood-stained fluid however milky colour fluid was noted to be draining 11 h post insertion. Further imaging revealed a left pleural effusion causing a mediastinal shift where, once drained, also revealed a chylothorax. The patient was managed conservatively with bilateral intercostal catheters and a no fat/low-fat diet. The patient was discharged day seven post removal of bilateral intercostal catheters.

Blunt traumatic tension chylothorax: Case report and mini-review of the literature

Tension chylothorax following blunt thoracic trauma is an extremely rare condition. Here we report such a case and review its management. A 31-year-old man was involved in a road traffic collision. The car rolled over and the patient was ejected from the vehicle. On arrival at the Emergency Department the patient was conscious and haemodynamically stable. Clinical examination of the chest and abdomen was normal. The patient had sustained fractures of the sixth cervical vertebra and the tenth thoracic vertebra, left pleural effusion, haematoma around the descending aorta and fracture of the right clavicle. The left pleural effusion continued to increase in size and caused displacement of the trachea and mediastinum to the opposite side. An intercostal chest tube was inserted on the left side on the second day. It drained 1500 mL of milky, blood-stained fluid. We confirmed the diagnosis of chylothorax by a histopathological examination of a cell block prepared from the left pleural effusion using Oil red O stain. The patient was managed conservatively with chest tube drainage and fat free diet. The chylothorax completely resolved on the eighth day after the injury. The patient was discharged home on day 16.

Bilateral chylhotorax after falling from height

Chylothorax is accumulation of chyle in the pleural cavity due to disruption of the thoracic duct. The causes can be classified as neoplastic, traumatic (iatrogenic or noniatrogenic), congenital, sporadic, spontaneous, and miscellaneous. A 22-year-old man with no feature in his history and family history was referred to emergency department with the case of falling from height. Abdominal computed tomogram (CT) revealed laceration of liver, grade 5 splenic laceration, fracture of the left acetabulum, and dislocation of the left hip. He was optimized for emergency splenectomy and close left hip reduction. On the 2nd day of the operation, bilateral chylotorax revealed. The treatment depends on its etiology, the amount of drainage, and the clinical picture. Treatment can be classified into 3 categories treatment of the underlying condition, conservative management (such as bed rest, nil by mouth or low fat medium chain triglycerides by mouth and total parenteral nutrition), and surgical management by ligation or clipping of the thoracic duct with open thoracotomy or video-assisted thoracoscopic surgery. The main purpose of surgical treatment is to stop the chylous leak.

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.

[Chylothorax]

Chylothorax, an uncommon cause of pleural effusion, is usually secondary to malignancy, trauma, congenital diseases, infections and superior vena cava thrombosis. The early diagnosis and treatment are important to prevent the most fearful consequence of chylothorax, the malnutrition with a compromised immunological status.

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.

Percutaneous Treatment of High-Output Chylothorax with Embolization or Needle Disruption Technique

Surgical ligation of the thoracic duct is associated with a high degree of morbidity; therefore, a minimally invasive approach is desirable. Herein, eight percutaneously treated patients are described. In four patients, the thoracic duct was embolized with use of coils and glue. In the other four patients, lymphatic ducts were disrupted by multiple needle punctures. The median chest tube drainage substantially decreased in both patient groups from more than 1,300 mL the day before the procedure to less than 300 mL 2 days after the procedure. The median times to chest tube removal were 7 days in the embolization group and 3.5 days in the needle disruption group.