Bilateral chylothorax following papillary thyroid carcinoma with cervical lymph node dissection: Case report and comprehensive review of the literature

This case analysis and literature review aim to identify the causes of bilateral chylothorax following thyroid cancer surgery, a rare yet serious complication.

We report 2 East Asian women who developed bilateral chylothorax after undergoing total thyroidectomy with neck lymph node dissection. Both patients presented with dyspnea and significant pleural effusion postoperatively.

Both patients were diagnosed with bilateral chylothorax based on clinical examination and imaging studies, including chest ultrasonography and X-rays.

In both cases, conservative management was initially implemented, involving chest tube drainage, total parenteral nutrition, and octreotide therapy. Surgical intervention was considered if conservative measures failed to control the chylous output.

Both patients showed gradual improvement with conservative treatment, ultimately resulting in successful resolution of pleural effusion and discharge from the hospital without complications.

For patients with bilateral chylothorax, conservative treatment should be the initial approach for small effusions. For moderate to large effusions, placement of a chest drainage tube is recommended, and surgical intervention should be considered if chyle volume exceeds 10 mL/(kg/d) for 48 to 72 hours or persists for more than 11 days following conservative treatment.