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}
  • Accepted 30 May 2017
  • Published 18 June 2017


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).

Figure 1

PA chest X-ray showing the anatomy of the thoracic duct. The thoracic duct is filled by a radio-opaque material that the interventional radiologist used to embolise the thoracic duct.

Figure 2

Anatomy of the thoracic duct on the lateral chest X-ray.

Learning points

  • As the number of patients with complex medical history and specialised procedures increases, we appreciate visualisation of common structures with traditional imaging modalities.

  • The presented chest X-ray highlights the anatomy of the thoracic duct, which became apparent after the embolisation procedure.


  • 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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