Chylothorax is accumulation of chyle in the pleural cavity due to disruption of the thoracic duct. The causes can be classified as neoplastic, traumatic (iatrogenic or noniatrogenic), congenital, sporadic, spontaneous, and miscellaneous. A 22-year-old man with no feature in his history and family history was referred to emergency department with the case of falling from height. Abdominal computed tomogram (CT) revealed laceration of liver, grade 5 splenic laceration, fracture of the left acetabulum, and dislocation of the left hip. He was optimized for emergency splenectomy and close left hip reduction. On the 2nd day of the operation, bilateral chylotorax revealed. The treatment depends on its etiology, the amount of drainage, and the clinical picture. Treatment can be classified into 3 categories treatment of the underlying condition, conservative management (such as bed rest, nil by mouth or low fat medium chain triglycerides by mouth and total parenteral nutrition), and surgical management by ligation or clipping of the thoracic duct with open thoracotomy or video-assisted thoracoscopic surgery. The main purpose of surgical treatment is to stop the chylous leak.
Chylothorax is accumulation of chyle in the pleural cavity due to disruption of the thoracic duct [
A 22-year-old man was referred to our hospital after falling from height. He has no feature in his history and family history. He was conscious and cooperative. Vital signs and laboratory tests were within normal limits. Abdominal ultrasonography revealed free fluid in perisplenic and perihepatic areas and Morrison pouch. It is more prominent in the perisplenic area. Abdominal computed tomogram (CT) revealed laceration of liver, grade 5 splenic laceration, fracture of the left acetabulum, and dislocation of the left hip; brain CT revealed air-fluid level in right maxillary sinus and both sphenoid sinuses, upper and medial wall fracture of right orbita; thorax CT revealed parenchymal laceration and contusional changes. He was optimized for emergency splenectomy and close left hip reduction.
Preoperative laboratory findings were as follows: WBC: 23600/mm3, Hb: 12.6 g/dL, Htc: % 44, platelets: 292000/mm3, glucose: 141 mg/dL, BUN: 22 mg/dL, Cr: 0.99 mg/dL, Na+: 140 mEq/L, K+: 2.37 mEq/L, and Cl−: 105 mEq/L. Postoperatively the patient was admitted to the intensive care unit. On the 2nd day of the operation, he was extubated without any problem. Right pleural fluid was detected in control chest X-ray after extubation (Figure
In this paper, a case was reported of a man who fell from height and was operated for splenic laceration and developed bilateral chylothorax on the 2nd day of the operation. Although chylothorax due to blunt trauma was reported in the literature, this patient has developed chylothorax on the left side one day after the detection of right side chylothorax.
T
The main purpose of surgical treatment is to stop the chylous leak [
Before the introduction of surgical ligation of the thoracic duct, the mortality rate from chylothorax was approximately 100% [
This case is a rare example of bilateral chylothorax resulting from falling from height and onset of bilateral pneumothorax in a patient with open and functioning bilateral basal chest tubes. The mechanism of chylothorax is thought to be a hyperextension injury to the spine. But we cannot explain the onset of bilateral pneumothorax.
The pleural fluid was chylous and contained high triglycerides concentration and low cholesterol level. We performed a conservative approach including tube thoracostomy, nil by mouth, and TPN, which resulted in regression of the chylous fluid and improvement of the patient. Medium chain triglycerides were not given to patient but TPN was applied to prevent malnutrition due to chylothorax and fasting.
In conclusion, early detection of the bilateral chylothorax due to blunt trauma resulted in early management. During the ICU stay daily imaging demonstrated the delay of left-sided chylothorax one day after the right-sided chylothorax. Conservative management resulted in successful treatment.
The authors declare that there is no conflict of interests regarding the publication of this paper.