Chylothorax is the presence of chyle in the pleural space. In the literature, there are few cases of late chylothorax. We present the case of a male with late tension chylothorax, a management algorithm, and the results of a recent literature review and its correlation to the case. We report the case of a 52-year-old male patient with late tension chylothorax, secondary to a stab wound in zone 1 of the neck. Tension chylothorax represents an absolute emergency. The success of this management will hinge on the individualization of each particular case.