Postoperative chylothorax successfully treated using conservative strategies

The anatomy of the thoracic duct varies considerably, rendering it prone to disruption during thoracic surgery. Chylothorax complicates up to 0.5% of all intrathoracic procedures, its morbidity requiring the surgeon's vigilance throughout the entire course of the patient's illness. The natural history of chylothorax includes cardiopulmonary dysfunction, immunosuppression, nutritional and electrolyte derangements, and, ultimately, sepsis and death. General criteria for conservative management of thoracic duct injuries have been described in surgical literature, yet in selecting the best treatment for the patient, surgeons rely heavily on their own experience and the patient's unique presentation. A variety of conservative strategies may be implemented with success in approximately 50% of all cases. The duration of conservative treatment may vary, but the futility of conservative efforts should be recognized early and surgical intervention not delayed. We report a case of a 42-year-old man who presented at our institution with chylothorax after posterior mediastinal mass resection. The patient was treated successfully by withholding oral food and fluids, instituting total parenteral nutrition, and draining with a thoracostomy tube. He was discharged home with a complete resolution of chylothorax on hospital day 8. We describe the patient's illness course and discuss current strategies in the conservative management of thoracic duct injury after mediastinal resection.