Resolution of chylothorax after positive end-expiratory pressure ventilation

Ligation of the thoracic duct has previously been recommended for adults with traumatic chylothorax when average daily chyle loss exceeds 1,500 mL/day over five days since such cases are usually refractory to medical management. We describe a case of traumatic chylothorax where chyle output exceeded 2 L/day for a week despite cessation of oral intake and institution of intravenous hyperalimentation. The chylothorax rapidly resolved when mechanical ventilation with positive end-expiratory pressure was begun for treatment of an acute respiratory distress syndrome. The artificial ventilation may have promoted tamponade of the injured lymphatic duct thereby accounting for the abrupt decrease in chyle flow the occurred.