Delayed chylothorax in the absence of radiological evidence of rib or vertebral body fractures following blunt trauma

Abstract

Our case report illustrates effective implementation of conservative measures without the need for more invasive procedures, which can be required in refractory cases. Our patient was a 42-year-old female who fell from a horse and presented with a 1-week history of dyspnoea. Investigations revealed her to have a large right chylothorax, which was treated conservatively with chest drainage and octreotide. The patient remained in hospital for a total of 3 days prior to being discharged home without further complications. Blunt traumatic chylothorax should be considered as part of the differential diagnosis in patients who present with ongoing dyspnoea or chest discomfort within a 2-week preceding history of blunt trauma. Radiological imaging should be mandatory and the absence of posterior thoracic fractures does not exclude the diagnosis. Conservative management with pleural drainage, medium-chain triglyceride diet and octreotide yielded excellent results in our case.

Octreotide Dosing in the Medical Management of Chyle Leak Following Otolaryngologic, Thoracic, and Trauma Surgery: A 9-Year Evaluation

“…10,19 Conservative management with octreotide has been explored in several case reports and case series in adults which reported total daily doses ranging from 150 to 750 µg. 1,[4][5][6]9,10,[12][13][14][15] There are no prospective randomized trials of octreotide in adults with chyle leak secondary to surgery or trauma.…”

“…1-3 Chylothorax is an uncommon sequela of thoracic trauma and surgery with a reported incidence of 0.2-9%, depending on the cause. 4-10 Mortality rates associated with chylothorax have been reported between 15.5% and 75% due to complications of dehydration, malnutrition, and immunologic compromise. 1,7,11…”

“…1,5,10 Surgical management via thoracic duct band ligation can be employed when chest tube drainage exceeds 1 L per day; however, surgical re-exploration may be a high risk option. 1,[3][4][5]10,12…”

“…12 Several case reports and small studies have described the role of octreotide in the successful management of chyle leaks; however, there are no comparative reports evaluating octreotide dosing for this indication. 1,[4][5][6][9][10][11][12][13][14][15] The purpose of this study was to evaluate octreotide dosing in the medical management of chyle leak in patients with otolaryngologic, thoracic, and trauma surgeries.…”