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

Area of Science:

• Medical Case Reports
• Thoracic Surgery
• Pulmonology

Background:

• Chylothorax, a rare condition involving lymphatic fluid in the pleural space, has diverse etiologies including trauma and malignancy.
• Idiopathic chylothorax accounts for approximately 15% of cases, highlighting diagnostic challenges.
• This report focuses on a delayed presentation of right-sided chylothorax following left-sided rib fractures.

Purpose of the Study:

• To present a unique case of delayed chylothorax occurring on the contralateral side of significant thoracic trauma.
• To discuss the management and outcomes of early surgical intervention in a complex chylothorax case.

Main Methods:

• A 70-year-old male sustained multiple left-sided rib fractures and left hemopneumothorax after a rollover accident.
• Following initial management, the patient developed right-sided pleural effusion, diagnosed as chylothorax based on high triglyceride levels.
• The patient underwent early surgical treatment, including thoracoscopic thoracic duct ligation and pleurectomy.

Main Results:

• Diagnosis of chylothorax was confirmed by pleural fluid analysis revealing 1000 mg/dL triglycerides.
• Despite conservative measures, fluid drainage increased, necessitating surgical intervention.
• Post-operative recovery was uneventful, with complete resolution of effusion and chest tube removal on postoperative day 14.

Conclusions:

• Delayed contralateral chylothorax can occur after significant thoracic trauma, even without direct injury to the affected side.
• Early surgical intervention is recommended for managing chylothorax in elderly patients with multiple traumas.
• This case underscores the importance of considering chylothorax in the differential diagnosis of persistent pleural effusion post-trauma.