Traumatic chylothorax in a young child: Case report and management

Abstract

IntroductionA chylothorax is an uncommon feature of paediatric chest trauma.Case reportWe report a case of traumatic chylothorax following blunt chest trauma in an eight year-old girl with polytrauma after being hit by a motor vehicle. She was initially found to have a bilateral frontal skull fracture extending into the left parietal area, pulmonary contusions, left posterior rib fractures, left clavicular fracture and a degloving injury of her left foot. On the fifth day of her admission she developed progressive dyspnoea with signs of a pleural effusion, which was confirmed radiologically and drained by tube thoracostomy. Biochemical analysis confirmed chylothorax, which was managed conservatively with a fat free diet. The chest tube was removed after it stopped draining over 20 mL per 12 hours and she made a full recovery.DiscussionInitial management of chylothorax is conservative with tube thoracostomy drainage and fat free diet. Traumatic chylothroax is a rare complication following chest trauma and can take days to develop and to become clinically apparent. It is therefore important to be vigilant for potential late complications in blunt chest trauma in children, especially if there are extensive rib fractures, a sign of major transmission of force to the thorax.

Traumatic chylothorax from a suprascapular stab wound

“…Major injuries can involve the esophagus and major vessels, producing hypovolemic shock (3). Traumatic chylothorax usually has a delayed onset of between 2 and 10 days, with a mean of 7 days (8). Our case presented on day 9 post-injury, day 3 after drainage of the accompanying hemothorax.…”

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

“…In our analysis, they accounted for 1% of the studied population [31], [68]- [70]. Rare, but important reasons for the development of the previously discussed effusion are: thrombosis (including thrombosis in the course of the nephritic syndrome), cancer (mainly cancers of the lymphatic system, such as: cystic hygroma, Hodgkin lymphoma, and non-Hodgkin lymphoma), intense vomiting and thoracic trauma (in 2,7% of the analyzed cases) [2], [27], [30], [37], [40], [68], [71]- [76]. In 12% of chylothorax cases, the cause could not be determined [3], [30], [34], [39], [77]- [81].…”

“…[49], [51-52], [54-58], [60-64], [66], [70][71][72][73][74][75][76][77][78][79][80][81], [84][85][86][87][88], [90][91][92][93], [95][96][97][98][99][100][101][102][103].…”

“…They include mucosal atrophy of the digestive tract, a decrease in hormone secretion in the digestive tract, and liver dysfunction [94]. Less common methods of nutritional treatment include low-fat diet (2.6 % patients [32], [38], [44], [49], [54], [57], [61], [92], [95], [96]), completely fat-free diet (5,8 % [13], [14], [20], [46], [51], [73], [75], [76], [97], [98]) or in infants -milk with modified fat content (7,5 % [3], [23], [84]). At the same time, authors of many publications do not provide specific diet modifications (10,9 %) [22], [26], [29], [31], [42], [60], [66], [70], [73], [80], [86], [99], [100].…”