Chylothorax caused by blunt chest trauma: a review of literature

Abstract

Chylothorax is the accumulation of chyle in the pleural cavity that typically contains a high concentration of triglycerides. Blunt chest trauma is a rare cause. The aim of this study is to review all of the reported cases of chylothorax caused by blunt chest trauma. Available databases were explored systematically for the condition and the eligible papers were included. The literature search revealed 30 studies with 39 cases, 72.3% of the cases were male, and 21.7% of the patients were female. The age range varied between 4 and 75 years with a mean age of 35.8 years. All of the patients were diagnosed after fluid sampling from the pleural fluid by thoracentesis and/or chest tube insertion. About 71.4% of the patients were treated successfully by conservative management: others (28.6%) were managed surgically. Although it is a rare condition, persistent milky drainage after blunt chest trauma should raise the suspicion of chylothorax. Pleural fluid sampling is the cornerstone of the diagnosis. In the majority of the cases, conservative treatment is quite enough. Surgery is indicated whenever non-operative measures failed.

Delayed Chylothorax Following Blunt Chest Trauma Treated with Repeated Lymphangiography: A Case Presentation

“…Chylothorax can be spontaneous or iatrogenic, with the latter accounting for most cases. About 0.4-2% of chylothorax cases occur during operations for esophageal disorders [1]. Penetrating chest trauma, such as gunshot or stab wounds, is another prevalent cause of chylothorax.…”

“…Penetrating chest trauma, such as gunshot or stab wounds, is another prevalent cause of chylothorax. In contrast, chylothorax caused by blunt trauma is a rare entity [1]. It is reportedly caused by abrupt vertebral column hyperextension leading to thoracic duct rupture, or by penetrating ductal injuries due to fractured vertebral pieces [1].…”

“…It is reportedly caused by abrupt vertebral column hyperextension leading to thoracic duct rupture, or by penetrating ductal injuries due to fractured vertebral pieces [1]. The latency period between initial blunt trauma and clinical manifestation of chylothorax ranges from a few minutes to as long as 20 years [1]. In most cases, chylothorax appeared within 2-7 days from the initial trauma [1].…”

“…Without adequate drainage, increasing thoracic pressure may cause cardiopulmonary compromise, and severe nutritional derangements may arise from continuous chylous leaks [2,3]. Chylothorax is mostly iatrogenic, with blunt trauma being a rare cause [1]. We present a rare case of delayed-onset chylothorax caused by blunt chest trauma with persistent high daily output.…”

“…Chylothorax refers to the accumulation of chylous effusion in the pleural cavity. It is diagnosed by the presence of milky white fluid with high triglyceride concentrations (> 110 mg/ dL) [1]. Chylothorax is associated with significant morbidity and mortality if left untreated [2,3].…”