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A 26-year-old white woman in the 35th week of pregnancy presented with severe dyspnea due to massive bilateral chylothorax, necessitating a low transverse cesarean section for delivery of a healthy baby.Conservative treatment consisting of bilateral closed tube thoracostomy and total parenteral nutrition was instituted but proved ineffective. A left thoracotomy was performed and multiple small lymphatic channels were ligated at the esophageal hiatus on both sides along with all tissue between the aorta and the azygos vein. After surgery the chyle effusion ceased and the patient was discharged on postoperative day 14. Although a chest CT scan 1 year after surgery did not show any abnormality in the lungs, pleurae or mediastinum, the patient (who was HIV negative) still presented with a severe combined immunodeficiency. Although an abdominal CT scan revealed numerous rounded, non-enhancing splenic lesions up to 1 cm l Corresponding author,

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