A Rare Case of Right-Sided Chylothorax Induced by Vertebral Osteophytosis in a Nonagenarian Patient.

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Chylothorax is an abnormal accumulation of lymphatic fluid in the pleural cavity, and it develops because of chyle leaking from the thoracic duct. The clinical presentation can be varied, while symptoms depend on its size and the rate of accumulation in the pleural space. Diagnosis is based on pleural fluid analysis, supported by various imaging studies to help determine the underlying pathology and locate the site of chyle leak. We report an extremely rare case of non-iatrogenic right-sided chylothorax in the absence of radiographically demonstrated bony damage which was related to vertebral osteophytosis in a 90-year-old man, who presented with worsening shortness of breath after a blunt trauma. On physical examination, the patient was found to be suffering from substantial right-sided pleural effusion with no radiographic evidence of traumatic injury. Imaging demonstrated diffused osteophytosis at the level of the lower thoracic vertebrae, which were puncturing the thoracic duct. We adopted conservative treatment, including thoracentesis and total parenteral nutrition, which resulted in the improvement and resolution of symptoms. Vertebral osteophytosis may damage the thoracic duct and cause chylothorax.