Thoracic duct embolization via chest tube for a patient with postoperative traumatic chylothorax

We present the case of a 53-year-old man who experienced a postoperative chyle leak after minimally invasive esophagectomy with mass ligation of the thoracic duct; conservative management failed. Interventional radiology was unsuccessful initially in accessing the cisterna chyli with conventional methods, yet ethiodized oil was noted at the tip of his right chest tube. The chest tube and its tract were used as an avenue to access the thoracic duct and successfully facilitate its embolization.

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.

Chylothorax caused by blunt trauma: Case review and management proposal

Chylothorax is a potentially devastating complication of lymphatic trauma of the thorax. To date, no recommendations have provided decision making support for prompt definitive treatment. We present a 53 year old male involved in a motor vehicle collision sustaining 9 left rib fractures with flail segments. He was treated non-operatively with a chest tube and no fat diet. A Case report review was performed and a proposed guideline for managing blunt trauma chylothorax in adult patients was developed. In low-output chylothorax, effective initial treatment begins with a no fat diet and chest tube. We propose that a low output leak be defined as <500 mL of initial output or <500 mL/day and can be managed non-operatively in nearly 100% of patients. High output injuries of >1000 mL of initial output will require surgical intervention and should be considered for prompt definitive care.

Diagnosis and management of traumatic bilateral chylothorax: a clinical conundrum

A 35-year-old man was admitted in the emergency department with a complaint of progressive dyspnoea and 4-day prior history of a road traffic accident. An initial evaluation was inconspicuous and he was discharged. Clinical examination and radiological imaging suggested bilateral pleural effusion for which bilateral intercostal drains were inserted. Further pleural fluid analysis aided the diagnosis of bilateral chylothorax. A conservative approach consisting of a fat-free diet, total parenteral nutrition and octreotide therapy was started. Upon failure of conservative management, thoracic duct ligation by thoracotomy was done. Chylous output decreased dramatically and subsequently, and the patient was discharged in a healthy condition. This case illustrates intricacies involved in the diagnosis and management of traumatic chylothorax. Also, conservative treatment forms the first line of management, but if ineffective, then early surgical intervention should be considered. Early diagnosis and timely intervention are keystone factors for a better outcome.

Bilateral Chylothorax Due to Blunt Trauma Without Radiographic Evidence of Traumatic Injury

Chylothorax represents an uncommon clinical entity with multiple etiologies. Chylothorax following blunt thoracic trauma is typically associated with posterior rib fractures or thoracic vertebral fractures or dislocations. The occurrence of a traumatic chylothorax in the absence of associated injuries is a rare event. We report a case of a 51-year-old patient who developed bilateral chylothorax after sustaining blunt trauma without radiographic evidence of traumatic injury. A 51-year-old male presented to the emergency department complaining of progressively worsening shortness of breath and associated chest pain for the prior one week following a fall down several concrete steps. On evaluation, the patient was found to have bilateral pleural effusions with no radiographic evidence of traumatic injury, including posterior rib or thoracic vertebral fractures. Subsequent thoracentesis and pleural fluid analysis were performed confirming the diagnosis of chylothorax. Management included repeated thoracentesis, diet modification and octreotide administration, which resulted in dramatic improvement and eventual resolution of symptoms. Non-iatrogenic traumatic bilateral chylothorax in the absence of other radiographically demonstrated bony or soft tissue injury is a rare event. Chylothorax should be considered in the differential diagnosis of patients presenting with chest pain or shortness of breath following blunt trauma and evidence of pleural effusion, even in the absence of obvious traumatic fracture or injury on radiographic imaging.