Simultaneous occurrence of chylothorax and subarachnoid pleural fistula after thoracotomy

A left chylothorax complicated elective left posterolateral thoracotomy and emergency decompressive laminectomy carried out on a 32-year-old woman with a benign neurofibroma. Failure of conservative therapy necessitated ligation of the thoracic duct and this in turn unmasked the concomitant subarachnoid-pleural fistula. Surgical repair and lumbar subarachnoid drainage were required to close the second fistula. The clinical setting, diagnosis and management of this uncommon condition are reviewed.