A 35-year-old man was admitted in the emergency department with a complaint of progressive dyspnoea and 4-day prior history of a road traffic accident. An initial evaluation was inconspicuous and he was discharged. Clinical examination and radiological imaging suggested bilateral pleural effusion for which bilateral intercostal drains were inserted. Further pleural fluid analysis aided the diagnosis of bilateral chylothorax. A conservative approach consisting of a fat-free diet, total parenteral nutrition and octreotide therapy was started. Upon failure of conservative management, thoracic duct ligation by thoracotomy was done. Chylous output decreased dramatically and subsequently, and the patient was discharged in a healthy condition. This case illustrates intricacies involved in the diagnosis and management of traumatic chylothorax. Also, conservative treatment forms the first line of management, but if ineffective, then early surgical intervention should be considered. Early diagnosis and timely intervention are keystone factors for a better outcome.
- medical management
- cardiothoracic surgery
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Contributors RJ: concept, design, analysis and/or interpretation. JS: analysis and/or interpretation, supervision, critical review. LG: data collection and/or processing. MG: literature search, writing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.