Blunt chest injury with chylothorax and thoracic vertebral fracture – multidisciplinary management

Abstract

Summary. Introduction. Chylothorax is the result of traumatic as well as nontraumatic events. The conservative approach is usually applied in the management of chylothorax. Surgical treatment is not commonly used and is considered only in specific patients. Case presentation. We describe a complicated algorithm that was used in treating a 70-year-old woman with Bechterew's disease. Admitted for healthcare after a fall, she suffered from a blunt chest injury with subsequent right-sided serial rib fracture with hemothorax and thoracic vertebral body fracture. The hyperextension of the ossified thoracic spine associated with Bechterew's disease caused the injury of the thoracic lymphatic duct. Simultaneous thoracic spine stabilization and surgical revision of the thoracic lymphatic duct from an anterior approach were indicated. Despite the urgency of thoracic spine stabilization, the procedure was postponed due to acute coronary syndrome, which was treated with drug-eluting stent insertion with a subsequent need for dual antiplatelet therapy. Thus, the procedure was performed 16 days after stent insertion. Conclusion. The diagnosis of chylothorax must be considered in case of thoracic injury with continuing waste to the chest tube and detection of well-expanded pulmonary parenchyma. Biochemical investigation of the effusion is the cornerstone in establishing the diagnosis of chylothorax.