A case of a traumatic chyle leak following an acute thoracic spine injury: successful resolution with strict dietary manipulation

Andrea M Pakula,Ruby A Skinner,Wendy Phillips

doi:10.1186/1749-7922-6-10

Andrea M Pakula, Ruby A Skinner + Show 1 more

Open Access

https://doi.org/10.1186/1749-7922-6-10

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Abstract

BackgroundChylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Thoracic duct ligation is often the treatment of choice in postsurgical patients; however the optimal treatment of this disease process after traumatic injury remains unclear [1]. We present a rare case of a thoracic duct injury secondary to a blunt thoracic spine fracture and subluxation which was successfully treated non-operatively.Case PresentationA 51 year old male presented as a tier one trauma code due to an automobile versus bicycle collision. His examination and radiographic work-up revealed fractures and a subluxation at the third and fourth thoracic spine levels resulting in paraplegia. He also sustained bilateral hemothoraces secondary to multiple rib fractures. Drainage of the left hemothorax led to the diagnosis of a traumatic chylothorax. The thoracic spine fractures were addressed with surgical stabilization and the chylothorax was successfully treated with drainage and dietary manipulation.ConclusionsThis unusual and complex blunt thoracic duct injury required a multidisciplinary approach. Although the spine injury required surgical fixation, successful resolution of the chyle leak was achieved without surgical intervention.

Highlights

The majority of reported cases of chylothorax are due to malignancy (50%) non-Hodgkin’s lymphoma
The spine injury required surgical fixation, successful resolution of the chyle leak was achieved without surgical intervention
Chylous pleural effusion is most commonly caused by malignancy, accounting for more than 50% of cases

Summary

Introduction

The majority of reported cases of chylothorax are due to malignancy (50%) non-Hodgkin’s lymphoma. Pertinent findings on secondary survey revealed bilateral chest wall tenderness to palpation, diminished breath sounds bilaterally, upper thoracic spine tenderness to palpation, a complete loss of motor function in his lower extremities, a loss of sensory function below the level of T4 and a Glascow Coma Scale (GCS) of 15. His American Spine Injury Association Motor Score was 50. The patient was discharged to an inpatient rehabilitation facility and was seen approximately two months after his injury in our clinic He still had complete motor paralysis of the lower extremities with a T2 sensory loss. His pulmonary status remained stable as he had no ongoing acute pulmonary issues and saturated 98-100% on room air

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Conclusions

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