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BMJ Case Reports 2017; doi:10.1136/bcr-2017-220769
  • Images in…

Chest X-ray of a patient with history of pleural effusion

  1. John Schirger
  1. Mayo Clinic Minnesota, Rochester, Minnesota, USA
  1. Correspondence to Dr Ewa Konik, konik.ewa{at}mayo.edu
  • Accepted 30 May 2017
  • Published 18 June 2017

Summary

The presented chest X-ray depicts the thoracic duct anatomy of a 50-year-old man who underwent heart transplantation. His postoperative course was complicated by Candida mediastinitis, treated with débridements and closure of the anterior chest wound with myocutaneous flaps. Postoperatively, he had persistent output from a right-sided chest tube. The fluid appeared milky and its triglycerides level was elevated at 254 mg/dL. The drainage persisted despite a low fat diet. The interventional radiologist identified a leak in the upper thoracic duct. It was embolised with coil and onyx. After the procedure, the chylous pleural effusions resolved. The thoracic duct has been visualised on subsequent chest X-rays (figures 1 and 2).

Footnotes

  • Contributors EK: drafting the manuscript. JS: mentorship.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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