Traumatic chylothorax after blunt thoracic injury: A case series from a level 1 trauma centre

Traumatic chylothorax is an uncommon complication of thoracic injury resulting from disruption of the thoracic duct or its tributaries. Non-iatrogenic blunt traumatic chylothorax is particularly rare and may present with delayed clinical features, making diagnosis challenging. We present a case series of four patients with blunt trauma-associated chylothorax managed at a level 1 trauma centre over a 22-year period. We aim to highlight patterns of delayed diagnosis, explore the relationship between injury level and chylothorax laterality, and describe the multidisciplinary management strategies used in this rare but clinically significant complication of thoracic trauma. All patients presented with pleural effusions following thoracic trauma, with diagnostic delays ranging from 2 to 10 days. Mechanisms of injury included falls and high-speed motor vehicle collisions, and associated injuries commonly involved rib or vertebral fractures. Diagnosis was confirmed with pleural fluid triglyceride analysis. Initial management consisted of thoracostomy drainage and dietary modification in all cases, with additional therapies including octreotide infusion and surgical pleurodesis when conservative measures failed. Chylous drainage volumes ranged from 903 mL to 3680 mL, with leak duration between 4 and 22 days. One patient developed significant complications related to prolonged chyle loss including malnutrition and infection. All cases ultimately achieved resolution. This case series highlights the delayed diagnosis of traumatic chylothorax following blunt thoracic trauma and underscores the importance of maintaining clinical suspicion in patients with evolving pleural effusions. Management requires a multidisciplinary approach, and while conservative measures are often effective, persistent high-output leaks may require pharmacological or surgical intervention.