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Bilateral spontaneous chylothorax presenting as a left-sided neck mass
Sarah Akbar1, Rajeev Advani2, Rohini Aggarwal3
1Salford Royal Hospital, Salford, UK sarah.akbar@doctors.org.uk.
BMJ Case Reports
|April 8, 2021
Summary
A rare case of bilateral spontaneous chylothorax occurred in a woman after neck hyperextension. Prompt treatment with nutritional support led to complete symptom resolution.
Area of Science:
- Medicine
- Pulmonology
- Thoracic Surgery
Background:
- Bilateral spontaneous chylothorax is a rare clinical presentation.
- It is infrequently reported, particularly in adult females without a history of trauma or surgery.
- Potential triggers include minor physical activities like neck hyperextension.
Observation:
- A 36-year-old woman presented with a tender neck mass, otalgia, and odynophagia.
- Physical examination revealed neck swelling extending to the chest wall.
- Imaging demonstrated inflammatory changes and bilateral costophrenic angle blunting.
Findings:
- Diagnostic pleural aspiration confirmed the presence of chyle, indicating chylothorax.
- The patient's symptoms resolved within 5 days after initiating total parenteral nutrition and a low-fat diet.
- No recurrence or complications were noted at 6-week follow-up.
Implications:
- This case highlights neck hyperextension as a potential, albeit rare, trigger for bilateral spontaneous chylothorax.
- Early diagnosis and prompt management, including nutritional therapy, are crucial for favorable outcomes.
- Further research may elucidate the precise mechanisms linking neck movements to chylothorax in susceptible individuals.
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