SESSION TITLE: Surgery Student/Resident Case Report Posters
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. It can cause cardiopulmonary abnormalities and may have significant nutritional, metabolic, and immunologic consequences. The majority of reported cases of chylothorax are due to malignancy. Chylothorax due to traumatic thoracic injuries, including iatrogenic post-surgical injuries, comprises approximately twenty-five percent of cases. Other iatrogenic complications, primarily related to central access catheters make up the remaining twenty-five percent. This disease process, if not properly recognized and treated can result in significant patient morbidity and mortaility. The available treatment modalities include conservative management with drainage and strict dietary regulation or more invasive approaches, specifically thoracic duct ligation.
CASE PRESENTATION: Presented is a rare case of a thoracic duct injury secondary to blunt thoracic spine trauma which eventually required operative repair. A sixty-one year old male presented as a trauma alert following a farming accident. His examination and radiographic work-up revealed rib fractures, a humeral fracture, as well as thoracic and lumbar fractures. In addition, he sustained bilateral hemothoraces secondary to the rib fractures.
DISCUSSION: Drainage of the right hemothorax led to the delayed diagnosis of a traumatic chylothorax following the initiation of enteral feeds. The diagnosis was confirmed based on the pleural fluid cytology. Conservative management including total parenteral nutrition failed; therefore the patient required surgical closure of the duct leak.
CONCLUSIONS: Traumatic transection of the thoracic duct due to blunt chest trauma is unusual and rare. In addition, can be difficult to treat especially with other traumatic injuries, it is often identified late. Despite management with drainage and strict dietary changes the need for surgical intervention may become necessary. A chylothorax should be considered in the differential of trauma patients who sustain blunt chest trauma. Especially when these patients have thoracic injuries and a pleural effusion. Patients who are symptomatic from chyle loss or have a high output chylothorax will require surgical intervention.
Reference #1: Benato C. Maganelli G. Terzi A. et al. (2005). Very Unusual Case of Post-Traumatic Chylothorax. The Annals of Thoracic Surgery.
Reference #2: Bonn J. (2000). Percutaneous Embolization of Thoracic Duct Injury. Circulation.
Reference #3: Ducko CT, LInden PA. Chapter 113. Management of Chylothorax. In: Sugarbaker DJ, Bueno R, Krasna MJ, Mentzer SJ, Zellos L, eds, Adult Chest Surgery. New York: McGraw-Hill.
DISCLOSURE: The following authors have nothing to disclose: Sara Honari
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