Postpneumonectomy chylothorax

Chylothorax complicating pulmonary resections is exceptional and management of this complication remains controversial. We report a case of chylothorax after a right pneumonectomy and radical subcarinal nodal dissection. Successful nonoperative management consisted of controlled tube drainage, fasting, and total parenteral nutritional support for a period of 2 weeks. A review of the literature reveals 27 other cases of this complication after intrapleural pneumonectomy: 12 were treated by conservative measures alone and 15 required surgical intervention. Factors that will determine the management and the ultimate success of conservative management include (1) a relative delay in initial occurrence, (2) a decrease in or complete cessation of leakage while receiving total parenteral nutrition, and (3) favorable lymphangiographic findings.