A Unique Case of Chylothorax Occurring Post-Chest Tube Insertion

Chylothorax is a relatively rare condition characterized by the accumulation of chyle, a milky lymphatic fluid, within the pleural space. It occurs because of disruption or obstruction of the thoracic duct or its tributaries, leading to chyle leakage into the pleural cavity. We present an interesting case of chylothorax that occurred as a complication post-chest tube insertion. A 66-year-old patient presented with hypotension and shortness of breath. Initial chest X-ray in the emergency room showed a right-sided hydropneumothorax requiring chest tube placement. Later on, the patient was transferred to the medical intensive care unit for respiratory failure. Chest tube drainage was initially serosanguineous but later changed to milky-white drainage. Pleural fluid analysis showed a triglyceride level of 208, confirming chylothorax. Conservative treatment was initiated with a low-fat diet and octreotide. The plan was to schedule the patient for thoracic duct embolization in view of continuous chylous drainage, but due to family preference, the procedure was deferred. This case report provides an overview of chylothorax, including etiologies and diagnostic options, and shows the importance of taking a multidisciplinary approach to finalize management strategies.