Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2016; 4(11): 380-384
Published online Nov 16, 2016. doi: 10.12998/wjcc.v4.i11.380
Blunt traumatic tension chylothorax: Case report and mini-review of the literature
Kamal Idris, Michael Sebastian, Ashraf F Hefny, Navidul Haq Khan, Fikri M Abu-Zidan
Kamal Idris, Intensive Care Unit, Al-Ain Hospital, 1006 Al-Ain, United Arab Emirates
Michael Sebastian, Ashraf F Hefny, Department of Surgery, Al-Ain Hospital, 1006 Al-Ain, United Arab Emirates
Navidul Haq Khan, Tawam Hospital, 15258 Al-Ain, United Arab Emirates
Fikri M Abu-Zidan, Department of Surgery, College of Medicine and Health Sciences, UAE University, 17666 Al-Ain, United Arab Emirates
Author contributions: Idris K was the treating Critical Care Physician, had the idea, read the literature, wrote the first version of the paper, and approved its final version; Sebastian M was the treating surgeon, participated in the idea, and approved the final version of the paper; Hefny AF participated in the idea, collected the data, and approved the final version of the paper; Khan NH performed the histopathology, participated in the idea, and approved the final version of the paper; Abu-Zidan FM participated in the idea, collected the data, read the literature, corrected the first version of the paper, repeatedly edited the manuscript, and approved its final version.
Institutional review board statement: Case reports do not require an evaluation by the Review Board at our institution.
Informed consent statement: The paper does not have any information that can identify the patient. Written informed consent for case reports was not required by the Ethical Committee of our hospital at the time of writing the first draft of this paper provided that the patient could not be identified. Trauma patients or their caregivers sign a general form accepting the use of their data in Al-Ain Hospital Trauma Registry for auditing and research purposes. The patient could not be contacted after discharge. As he was an expatriate worker it is likely that went back to his own country.
Conflict-of-interest statement: None declared by all authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fikri M Abu-Zidan, MD, FACS, FRCS, PhD, Dip Applied Statistics, Professor, Consultant Surgeon (Acute Care Surgery and Disaster Medicine), Point-of-Care Sonographer, Statistical Consultant, Department of Surgery, College of Medicine and Health Sciences, UAE University, 17666 Al-Ain, United Arab Emirates. fabuzidan@uaeu.ac.ae
Telephone: +971-3-7137579 Fax: +971-3-7672067
Received: April 10, 2016
Peer-review started: April 12, 2016
First decision: May 19, 2016
Revised: May 31, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: November 16, 2016
Processing time: 216 Days and 21.8 Hours
Abstract

Tension chylothorax following blunt thoracic trauma is an extremely rare condition. Here we report such a case and review its management. A 31-year-old man was involved in a road traffic collision. The car rolled over and the patient was ejected from the vehicle. On arrival at the Emergency Department the patient was conscious and haemodynamically stable. Clinical examination of the chest and abdomen was normal. The patient had sustained fractures of the sixth cervical vertebra and the tenth thoracic vertebra, left pleural effusion, haematoma around the descending aorta and fracture of the right clavicle. The left pleural effusion continued to increase in size and caused displacement of the trachea and mediastinum to the opposite side. An intercostal chest tube was inserted on the left side on the second day. It drained 1500 mL of milky, blood-stained fluid. We confirmed the diagnosis of chylothorax by a histopathological examination of a cell block prepared from the left pleural effusion using Oil red O stain. The patient was managed conservatively with chest tube drainage and fat free diet. The chylothorax completely resolved on the eighth day after the injury. The patient was discharged home on day 16.

Keywords: Trauma; Injury; Chest; Chylothorax; Thoracic duct

Core tip: Tension chylothorax is an extremely rare complication of blunt chest trauma because the thoracic duct is well protected within the chest cavity. When chyle accumulates in the pleural cavity, it may cause cardiovascular, respiratory, or nutritional, complications. Here we report a patient who had tension chylothorax following blunt chest trauma and review its management.