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

Abstract

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