An Unusual Case of Non-traumatic Chylothorax

Abstract

Chylothorax refers to the presence of chyle in the paraaortic space. This entity most commonly occurs from injury to the thoracic duct, which carries chyle from the gastrointestinal tract to the bloodstream. Common etiologies around traumatic chylothorax include iatrogenic causes, such as surgical procedures near the thoracic duct and penetrating and blunt injuries to the chest. We present a case of a 49-year-old female who initially presented to the hospital with progressively worsening dyspnea leading to acute hypoxic respiratory failure requiring intubation and admission to the ICU. The patient's presentation was initially thought to be due to and managed as an infectious process with empyema and septic shock until a diagnosis of nontraumatic chylothorax was established. In this article, we report a complicated case of chylothorax, initially masquerading as an infectious pulmonary process. We hope to raise this entity high on the differential when clinicians are confronted with the task of managing patients with similar presentations, which will, in turn, prevent delayed diagnosis and the unnecessary use of antibiotics.

Keywords: bilateral chylothorax; non traumatic; non-hodgkins lymphoma; pleural empyema; thoracic duct injury.

Figure 1. CT of the chest on the day of admission

Blue arrows indicate large bilateral pleural effusions; Red arrows indicate severe bilateral pneumonia

Figure 2. Chest X-rays

Left: day of admission with severe bilateral pulmonary disease; Right: Day of discharge with the resolution of the disease