Tension chylothorax following blunt neck injury: case report

INTRODUCTION AND IMPORTANCE: Chyle is tryglyceride reach fluid absorbed from the intestines. A total of 1500 ml–2400 ml of chyle flows through thoracic duct per day. CASE PRESENTATION: A 15 years old boy accidentally hit himself with a stick while he was playing with a rope attached to the stick. He was hit on the left side of anterior neck in zone one territory. He came seven days after the trauma when he experienced a progressively worsening shortness of breath and a bulge at the trauma site that appears with each breath. On exams, he had features of respiratory distress. The trachea was significantly shifted to the right side. There was dull percussion note on the entire left hemichest with decreased air entry. Chest x-ray showed massive left pleural collection with mediastinal shift to the right side. Chest tube was inserted and approximately 3,000 ml of milky fluid was evacuated. These continued for the following three days for which repeated thoracotomies were done for an attempt to obliterate the chyle fistula. The final successful surgery done was embolization of the thoracic duct with blood coupled with total parietal pleurectomy. After staying for approximately one month in the hospital, the patient was safely discharged improved. DISCUSSION: Chylothorax following blunt neck injury is very rare. Chylothorax with significant output leads to malnutrion, immunocompromization and high rate of mortality without timely intervention. CONCLUSION: Early therapeutic intervention is the core for good patient outcome. Decreasing thoracic duct output, adequate drainage, nutritional support, lung expansion and surgical intervention are the pillars of chylothorax management. The surgical options of thoracic duct injury are mass ligation, thoracic duct ligation, pleurodesis and pleuroperitoneal shunt. Intraoperative thoracic duct embolization with blood, as we have used in our patient, needs further study.