Interaction of the p55 tumor necrosis factor receptor 1 (TNF-R1)-associated signal transducer TRADD with FADD signals apoptosis, whereas the TNF receptor-associated factor 2 protein (TRAF2) is required for activation of the nuclear transcription factor nuclear factor kappa B. TNF-induced activation of the stress-activated protein kinase (SAPK) was shown to occur through a noncytotoxic TRAF2-dependent pathway. TRAF2 was both sufficient and necessary for activation of SAPK by TNF-R1; conversely, expression of a dominant-negative FADD mutant, which blocks apoptosis, did not interfere with SAPK activation. Therefore, SAPK activation occurs through a pathway that is not required for TNF-R1-induced apoptosis.

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Blunt chest trauma is a rare cause of chylothorax because thoracic duct is well protected by the spine posteriorly and mediastinal contents anteriorly. Ribs or vertebral fractures are often associated but isolated chylothorax has been described. Thoracic duct injury may be due to stretching over the spine, or to shearing of the duct by the right crus of the diaphragm. Chylothorax can be associated with high rates of morbidity and mortality and early diagnosis is of paramount importance in order to adequate and prompt therapy. Chilothorax is well distinguishable in CT scan but the diagnosis must be confirmed by analysis of the pleural fluid. The optimal treatment for traumatic chylothorax is unclear and a challenging clinical problem. In this article, we describe the clinical manifestations, radiologic findings, and successful medical treatment of a patient with post traumatic chylothorax diagnosed in an emergency setting.