Traumatic tension chylothorax: Lessons from a rare complication of thoracic spinal trauma

Abstract

Injury to the thoracic duct following blunt trauma can rarely result in tension chylothorax. We report a case of traumatic tension chylothorax in a young man with cervical and thoracic spine injuries after he was hit by the open luggage compartment of a passing bus. Diagnosis was made on the fourth day following injury when he became short of breath during physiotherapy, and then deteriorated rapidly with haemodynamic compromise. The tension chylothorax was treated with intercostal drainage leading to immediate resolution of cardiorespiratory function. No further surgical intervention was required. This case highlights three important learning points: pleural fluid, not just air, can cause tension; seriously injured patients should have a multidisciplinary trauma team assessment on arrival to hospital and when reviewing radiographs, all the structures should be carefully examined, not just those that the study was performed to examine.