Nonoperative Management of Traumatic Chylothorax

Kumar, Subodh; Mishra, Biplab; Krishna, Asuri; Gupta, Amit; Sagar, Sushma; Singhal, Maneesh; Misra, Mahesh Chandra

doi:10.1007/s12262-012-0798-8

Cited by 8 publications

(9 citation statements)

References 12 publications

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“…Indications for the operation treatment of chylothorax are as follows: when the daily chyle leak exceeds 1 l/day for a period more than five days [16], or 1.5 l/day [17], a leak persists for more than two weeks (100 ml/day > 2 weeks), and the drain output remains unchanged over one to two weeks [18]. When we were considering surgical treatment, which was necessary with this patient due to the failure of non-surgical treatment, we took into account that the best option is ligation of the thoracic duct, and the same technique is confirmed by other recent papers [18,19]. Intraoperatively, we identified the thoracic duct and ligated it at the level above the right diaphragm, which is in accordance with similar cases.…”

Section: Discussionmentioning

confidence: 61%

A rare case of traumatic chylothorax after blunt thoracic trauma

et al. 2017

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Introduction Chylothorax is an accumulation of chyle in the pleural cavity due to a disruption of the thoracic duct. Traumatic chylothoraces are usually a result of a penetrating trauma and disruption of the thoracic duct, but blunt traumatic chylothorax is a rare condition. The aim of this paper is to present a rare case of traumatic chylothorax after blunt thoracic trauma. Case Outline We present a case of traumatic chylothorax after blunt thoracic trauma in a patient injured in a motor vehicle accident. The patient had a right-sided fracture of rib XI, hydropneumothorax, lung contusion, and signs of pneumomediastinum. We performed thoracic drainage, but a few days later, according to the increase of amount of the fluid daily drained, and the confirmation of laboratory findings of the analyzed fluid, we made a diagnosis of chylothorax and the patient underwent a thoracotomy, where we sutured the thoracic duct. Conclusion Chylothorax should be considered in patients after chest trauma if they develop a milky pleural effusion. Analysis of pleural fluid and level of triglycerides is important for the diagnosis and treatment of chylothorax.

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Section: Discussionmentioning

confidence: 61%

A rare case of traumatic chylothorax after blunt thoracic trauma

et al. 2017

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“…Chylothorax is almost always an incidental finding post insertion of an intercostal catheter which is subsequently found to drain milky pleural fluid [3] . It is indistinguishable from a haemothorax on standard chest X-rays [7] . The diagnosis of chylothorax can be confirmed with the measurement of pleural fluid triglyceride or chylomicron levels [3] , [4] .…”

Section: Discussionmentioning

confidence: 91%

Massive bilateral chylothorax post blunt trauma

Kozul

Jassal

Judson

2017

Trauma Case Reports

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Chylothorax caused by blunt trauma is extremely rare. We present a case of bilateral massive chylothorax post blunt trauma and a review of the literature regarding the identification and management of this rare diagnosis. An eighteen-year-old male was involved in a motor vehicle crash where he sustained multiple injuries including a right, moderate to large, haemopneumothorax, a small left haemopneumothorax, left T8, T9, L1 and L2 acute transverse process fractures and fractures of bilateral 11th ribs. An intercostal catheter was inserted on the right side which initially drained blood-stained fluid however milky colour fluid was noted to be draining 11 h post insertion. Further imaging revealed a left pleural effusion causing a mediastinal shift where, once drained, also revealed a chylothorax. The patient was managed conservatively with bilateral intercostal catheters and a no fat/low-fat diet. The patient was discharged day seven post removal of bilateral intercostal catheters.

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“… 2 Causes of non-traumatic chylothorax primarily include neoplastic, congenital, inflammatory, and idiopathic etiologies. 3 , 6 Malignancy (usually lymphoma) is considered the most common cause in non-traumatic cases. 4 , 6 In the less commonly occurring traumatic chylothorax, iatrogenic etiologies (approximately 80% of cases) are usually the cause.…”

Section: Discussionmentioning

confidence: 99%

“…Mortality rates remain high with an incidence up to 15.5%. 3 Diagnosis is often challenging and frequently delayed. 4 , 5 The clinical scenario in the trauma setting typically involves associated rib or vertebral fractures, or dislocations that may directly disrupt the thoracic duct.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Chylothorax Due to Blunt Trauma Without Radiographic Evidence of Traumatic Injury

Mohamed

Alshenawy

Kegarise

et al. 2017

Clinical Practice and Cases in Emergency Medicine

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Chylothorax represents an uncommon clinical entity with multiple etiologies. Chylothorax following blunt thoracic trauma is typically associated with posterior rib fractures or thoracic vertebral fractures or dislocations. The occurrence of a traumatic chylothorax in the absence of associated injuries is a rare event. We report a case of a 51-year-old patient who developed bilateral chylothorax after sustaining blunt trauma without radiographic evidence of traumatic injury. A 51-year-old male presented to the emergency department complaining of progressively worsening shortness of breath and associated chest pain for the prior one week following a fall down several concrete steps. On evaluation, the patient was found to have bilateral pleural effusions with no radiographic evidence of traumatic injury, including posterior rib or thoracic vertebral fractures. Subsequent thoracentesis and pleural fluid analysis were performed confirming the diagnosis of chylothorax. Management included repeated thoracentesis, diet modification and octreotide administration, which resulted in dramatic improvement and eventual resolution of symptoms. Non-iatrogenic traumatic bilateral chylothorax in the absence of other radiographically demonstrated bony or soft tissue injury is a rare event. Chylothorax should be considered in the differential diagnosis of patients presenting with chest pain or shortness of breath following blunt trauma and evidence of pleural effusion, even in the absence of obvious traumatic fracture or injury on radiographic imaging.

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Nonoperative Management of Traumatic Chylothorax

Cited by 8 publications

References 12 publications

A rare case of traumatic chylothorax after blunt thoracic trauma

A rare case of traumatic chylothorax after blunt thoracic trauma

Massive bilateral chylothorax post blunt trauma

Bilateral Chylothorax Due to Blunt Trauma Without Radiographic Evidence of Traumatic Injury

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