Bilateral Pleural Chylothorax from A Blunt Chest Trauma

Abstract

Introduction: Bilateral traumatic chylothorax is a very rare condition. Approximately80% of chylothorax are unilateral and usually 2/3 of cases on the right side [1]. The chyle leakage shows a milky white appearance, inexhaustible, in a consideration amount. Purpose: To report the management of bilateral traumatic chylothorax as a very rare condition. Material and methods: We present a patient with bilateral pleural chylothorax from a blunt chest trauma which is combined with a vertebral thoracal fracture of Th8, Th10.We present the diagnostic basis, treatment and evolution of chilies leakage. Results: A 36 years old man involved in a car crash. He was hospitalized with a diagnose such as right pleural effusion and thoracal vertebral fractures of the Th8, Th10.2 days after trauma the scan examination showed a large amount of effusion in the right hemithorax and minimal effusion in the left hemithorax. From the drainage tube in the right pleural cavity there was a flow of about 1000ml with a milky appearance. The biochemical analyses of the pleural effusion showed the presence of triglycerides with more than 1.24mmol /l and the cholesterol level with less than 5.18mmol/l which support the diagnosis of chylothorax. Initial treatment was conservative. A zero nutritional regimen was implemented for the first 10 days, being replaced by total parenteral nutrition such as plasma, albumin, electrolytes, vitamins. After that we passed to a fat-free nutritional diet. In the scan examination 6 days after the trauma, there was an increase in the amount of pleural effusion on the left side. A chest tube was performed from which there was 700 ml leakage, which had the appearance of chyle. The biochemical tests confirmed the diagnose of chylothorax. The chest tube of the left pleural cavity was removed after 5 days. The chyle leakage from the right pleural cavity has continued for about 3 weeks in a quantity ranging from 150-300 ml in 24 hours. After this period, approximately for 1 week the chyle leakage was in an amount of less than 1000ml in 24 hours. In the 5th week, the chest tube was removed, since the leaks were reduced to about 20-30 ml in 24 hours. The patient left the hospital after 30 days. The patient was completely recovered. Conclusions: The case was managed conservatively, based on a bilateral pleural drainage and a diet without fats, which proved to be successful.