Milky fluid from where? you are about to find out…

Cesar Peralta MD, Jose Ramos MD


Traumatic chylothorax most commonly occurs after thoracic surgeries with a few cases reported in patients after abdominal surgery. Effusions usually are caused by a pleural reaction during the postoperative period. However, this can also occur from disruption of the thoracic duct during the surgical procedure. The initial approach is conservative with supportive measures, including drainage by ultrasound-guided thoracentesis and diet modification, and surgery is rarely needed. Having a medical history preceding abdominal surgery is always important to consider the possibility of a pancreatic pleural fistula, which can be excluded by an abdominal computed tomography. Lymphangiography is considered the gold standard diagnostic tool, but its use is limited to cases unresponsive to conservative measures. In this patient, a lymphangiography or surgical intervention was not performed since the patient improved after initial management with no recurrent pleural effusion. A new pleural effusion after abdominal surgery must include chylothorax in the differential diagnosis.

Keywords: Traumatic chylothorax, hiatal hernia repair, thoracic duct, lymphangiography, abdominal computed tomography

Article citation: Peralta C, Ramos J. Milky fluid from where? you are about to find out… The Southwest Respiratory and Critical Care Chronicles 2023;11(47):38–41
From: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
Submitted: 10/31/2022
Accepted: 3/26/2023
Conflicts of interest: none
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International License.