Delayed right chylothorax after left blunt chest trauma: a case report

Abstract

BackgroundChylothorax is a disease that has various causes such as neoplasm, infection, post-surgery trauma, congenital, and venous thrombosis. In approximately 15% of cases of chylothorax, the exact cause is unknown. We report a case of delayed occurrence of right chylothorax in a patient who had multiple segmental ribs fracture on his left side.Case presentationA 70-year-old Asian man had a “rollover” accident in which the cultivator he was driving overturned. He presented to our hospital with the main complaint of severe dyspnea. On chest computed tomography, multiple ribs fracture from the first to the eighth rib of the left side of his chest and left-sided hemopneumothorax were presented, but there was no evidence of fracture in the right side of his chest.After closed thoracostomy, an emergency operation for open reduction of fractured ribs was performed. On the fifth postoperative day, tubal feeding was performed. On the next day, a plain chest X-ray image showed pleural effusion of the right side of his chest. After insertion of a small-bore chest tube, 3390 ml of fluid for 24 hours was drained. The body fluid analysis revealed triglycerides levels of 1000 mg/dL, which led to a diagnosis of chylothorax. Although non-oral feeding and total parenteral nutrition were sustained, drain amount was increased on the fifth day. Surgical treatment (thoracoscopic thoracic duct ligation and pleurectomy) was performed in the early phase. The right chest tube was removed on the 14th postoperative day after the effusion completely resolved and he was uneventfully discharged.ConclusionsIn this case, as our patient was in old age and had multiple traumas, surgical treatment for chylothorax needed to be performed in the early phase.

Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

“…Though more common in patients with penetrating trauma, blunt trauma can also damage the thoracic duct during hyperextension of the spine or through damage to surrounding tissues leading to obstruction and rupture of the thoracic duct. 58,59 Only 20% of patients with chylothorax following blunt trauma have rib or spine fractures, 60 and chyle leaks can arise regardless of the lack of vertebral fracture or displacement. 58 Symptoms of chylothorax may develop only 2 to 10 days after the initial injury.…”

“…58,59 Only 20% of patients with chylothorax following blunt trauma have rib or spine fractures, 60 and chyle leaks can arise regardless of the lack of vertebral fracture or displacement. 58 Symptoms of chylothorax may develop only 2 to 10 days after the initial injury. 61,62 Initially, patients with a chylothorax can present with dyspnea, and those with chylous ascites may additionally have nausea, abdominal pain, and increased abdominal girth.…”

“…57,63 If left untreated, chyle leaks can lead to hypovolemia, electrolyte disturbances, malnutrition, and eventually immunosuppression. 58 Diagnosis is made through fluid analysis by paracentesis or thoracentesis. 57,59 Conservative treatment of chylothorax, including diet, chest tube placement, and chemical pleurodesis, is successful in 50 to 88% of cases, and is reasonable to attempt for at least 2 weeks, with some suggesting up to 4 weeks.…”

“…57,59 Conservative treatment of chylothorax, including diet, chest tube placement, and chemical pleurodesis, is successful in 50 to 88% of cases, and is reasonable to attempt for at least 2 weeks, with some suggesting up to 4 weeks. 58 However, high-output leaks of !1.5 L/day or !1 L/day for 5 days, should undergo intervention. 59 Surgical treatment of chylothorax is complicated by the highly variable anatomy of the lymphatic system with morbidity and mortality rates of up to 38.8 and 2.1%, respectively.…”

Chylothorax caused by blunt chest trauma: a review of literature

“…Iatrogenic cases are accounted for the majority of conditions, predominantly, during operation for the esophageal diseases (0.4% to 2%) [4]. Penetrating chest trauma in the form of gunshot or stab wounds is the second most prevalent cause of chylothorax [5]. The precise etiology of the disease is not well recognized in nearly 15% of the cases [6].…”