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Case Reports
. 2025 Mar;16(5):e70036.
doi: 10.1111/1759-7714.70036.

Chylothorax After Thoracic Surgery: How We Manage It

Alberto Busetto  1 , Giorgio Cannone  1 , Luigi Lione  1 , Alessandro Bonis  1 , Vincenzo Verzeletti  1 , Michele Battistel  2 , Alessandro Rebusso  1 , Samuele Nicotra  1 , Andrea Dell'Amore  1 , Federico Rea  1
Affiliations
Case Reports

Chylothorax After Thoracic Surgery: How We Manage It

Alberto Busetto et al. Thorac Cancer. 2025 Mar.

Abstract

Chylothorax is a rare but insidious condition, characterized by the accumulation of chyle in the pleural space, which is particularly common after cardiothoracic surgeries. It presents significant challenges in both diagnosis and treatment. In this technical report, we present our experience in managing four cases of postsurgical chylothorax, each one treated with a different approach. The first and second cases were successfully managed with Lipiodol lymphangiography, which allowed for the visualization and occlusion of the injured lymphatic duct, leading to the resolution of the chylothorax. The third case involved thoracic duct embolization, a procedure that resulted in the closure of the duct responsible for the chylous effusion. The last case involved a patient who developed left-sided chylothorax following a pulmonary resection. The patient experienced chylous leakage early in the postoperative period and underwent a revision thoracoscopy for hemostasis and thoracic duct ligation. During the procedure, indocyanine green (ICG) fluorescence was used to effectively identify and ligate the injured chylous duct. This case series highlights the variety of therapeutic strategies available for the management of chylothorax, emphasizing the importance of a structured, stepwise approach tailored to the specific needs of each patient.

Keywords: chylothorax; indocyanine green fluorescence; lymphangiography; lymphatic embolization; thoracic surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Evidence of contrast agent accumulation in the left pleural cavity and along the lymphatic chain from the inguinal lymph nodes, as detected through a chest CT scan.
FIGURE 2
FIGURE 2
Attempt to embolize the thoracic duct while ascending the opacified abdominal lymphatic system through percutaneous access.
FIGURE 3
FIGURE 3
ICG‐fluorescence highlighting the leakage site in the left subcarinal space, along with the metal clips used to close it.
FIGURE 4
FIGURE 4
Diagnostic and therapeutic flowchart used for the management of chylothorax in our Thoracic Surgery Unit.
See this image and copyright information in PMC

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