Chylous Ascites Following Thoracic Drainage in a Patient With Previously Undiagnosed Cirrhosis

We report a rare case of acute chylous ascites developing shortly after insertion of a Seldinger chest drain for left-sided empyema in a man in his 60s with previously unrecognised liver cirrhosis. Pleural fluid cultures grew Dialister pneumosintes and Prevotella intermedia, consistent with an odontogenic source. Within days, the patient developed rapidly accumulating milky ascites with elevated triglycerides, confirming chylous ascites. Imaging demonstrated previously occult liver cirrhosis, suggesting an underlying predisposition to lymphatic hypertension. The temporal association with thoracic intervention suggested iatrogenic lymphatic disruption in a patient predisposed by cirrhosis. Conservative management with dietary fat restriction and supportive care led to complete resolution. This case emphasises the need to recognise chylous ascites as a potential complication of thoracic procedures and to consider underlying lymphatic vulnerability in patients with occult liver disease.