Non-Iatrogenic Traumatic Chylothorax: A Single Centre Case Series Study

Background: Chylothorax is a condition in which chyle (lymphatic fluid containing protein, triglycerides, and lymphocytes) is seen in the pleural space. The underlying etiologies of chylothorax are classified as traumatic or non-traumatic, which guides treatment approaches. Non-traumatic chylothorax was once more prevalent, and was associated with cancer, infection, or inflammatory processes. Traumatic chylothorax is often caused by damage to the thoracic duct, either by direct trauma or as a postoperative/iatrogenic complication. Objective: This study aimed to evaluate the clinical characteristics, management strategies, and outcomes of patients with non-iatrogenic traumatic chylothorax. Patients and methods: This case series study retrospectively analyzes traumatic chylothorax cases treated between April 2018 and March 2024. Results: Mean age was 32.6 ± 12.7 years. Males were more frequent than females (88.9% and 11.1% respectively). Bomb blast was the main mode of trauma (66.7%). Two thirds (66.7%) had right affection. Initial chest drainage (ICD) (mL), ICD total drainage (mL) and ICD duration (hours) were higher in cases with right laterality. Good response was in majority of cases (88.9%), the only poor case (11.1%) had right laterality. Infection and dehydration were infrequent (22.2% and 11.1% respectively). All cases with such complications had right laterality. Mean hospital length of stay was 11.8 ± 4.6 days, it was higher in cases with right than left laterality (13.3 ± 4.8 versus 8.7 ± 2.1 days). Conclusion: This study provided valuable insights into the management of non-iatrogenic traumatic chylothorax, emphasizing the efficacy of conservative treatment approaches. With a sample of nine cases over a six-year period, our findings demonstrated that conservative management (including dietary modification, fluid replacement, monitoring of protein levels, and adjunctive use of octreotide) successfully resolved chylothorax in 88.9% of cases. This high success rate underscored the potential of non-invasive management for chylothorax resulting from trauma, particularly in cases without extensive thoracic structural damage.