Delay Traumatic Chylothorax after Gunshot: A Case Report

Abstract

Background: Chylothorax is the occurrence of chyle in the pleural space due to damage or obstruction of the thoracic duct. Its etiology can be traumatic or nontraumatic. If left untreated, chylothorax may yield an overall 50% mortality rate.

Objective: To present a case of chylothorax secondary to a gunshot lesion as well as to review current concepts about chylothorax and its treatment.

Materials and Methods: Case report: A 22-year-old Thai man who complaint progressive chest pain and dyspnea on exertion for two weeks after being discharged from a traumatic gunshot with right hemothorax after treatment with pleural drainage and retained gunshot at left lower lung. Cardiovascular examination revealed normal. Chest examination revealed decreased breath sound at the right thorax. The chest X-ray (CXR) showed a massive pleural effusion. Management was based on pleural drainage and pleural fluid analysis to confirm the diagnosis of chylothorax.

Results: Our patient underwent pleural drainage and fasting for about 1 week with parenteral nutrition but failed conservative treatment. Surgical treatment becomes an option in this case. We approached video assisted right minithoracotomy in identifying and ligating the thoracic duct and performed a surgical pleurectomy of the right thorax. Post-operative, the flow rate through pleural drainage decreased, and pleural fluid characteristics were changed to serum fluid. CXR showed no pleural effusion. The patient was discharged from the hospital 1 week after surgery.

Conclusion: In this case report, we emphasize the late traumatic chylothorax after the gunshot. Chylothorax requires a high index of clinical suspicion for diagnosis. This case report demonstrates that timely and appropriate treatment is essential to prevent associated complications.