There are multiple methods of accessing the thoracic duct for embolization or disruption, including fluoroscopic guided transabdominal puncture of the cisterna chyli, direct ultrasound access, and retrograde catheterization. We present a chylothorax patient in whom the cisterna chyli was not visualized, and retrograde catheterization or ultrasound access of the thoracic duct was not possible. We were able to disrupt the thoracic duct through a CT-guided transpulmonary approach in the high visceral mediastinum. This approach could be considered for chylothorax management, particularly in patients with a chest tube in place.