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

Abstract

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.

Massive bilateral chylothorax post blunt trauma

“…Chylothorax caused by blunt trauma is extremely rare [1] , [2] , [3] . We present a case of bilateral massive chylothorax post blunt trauma.…”

“…Chylothorax post blunt thoracic trauma is an extremely rare condition, with the incidence estimated to be 0.2% to 3% [6] . The rarity of this condition is attributed to the well-protected position of the thoracic duct within the chest cavity [3] , [6] . The exact mechanism of thoracic duct injury is unclear in blunt traumatic chylothorax, however, most the authors agree that it can be attributed to a fracture or other injury to the neighboring thoracic spine which subsequently causes a disruption to the thoracic duct [1] , [2] , [4] .…”

The use of octreotide in the treatment of chylothorax

“…Chylothorax is almost always an incidental finding post insertion of an intercostal catheter which is subsequently found to drain milky pleural fluid. [4] A chest X-ray with a lateral and anteroposterior view confirms the presence of a pleural effusion and gives a starting point for monitoring. Computed tomography does not provide supplementary information and thus is not indicated.…”

“…The timing of surgical management is debatable, however, generally conservative management is advised for at least two weeks before considering alternative interventional procedures [4] such as open mass ligation through an open thoracotomy [29] or newer techniques such as ligation via thoracoscopy and thoracic duct embolisation. [6] The likelihood of successful conservative management if drastically reduced when the daily chyle output exceeds 1000 ml/day for >5 days [9] or 1500 ml/day in an adult or >100 ml/kg body weight per day in a child.…”

Perioperative Considerations for Chylothorax

“…26 The vast majority of these injuries are postoperative but nonoperative blunt and penetrating injures have been described. 27, 28 Atraumatic disease can be secondary to a variety of lymphatic disorders; however, malignancy is the leading cause, with lymphomatous malignancies being more frequently associated than solid organ malignancies. 24 …”