Successful conservative management of high output chylothorax following blunt chest trauma in low resource settings: a case report

Introduction: Traumatic chylothorax is an uncommon complication of blunt thoracic trauma caused by disruption of the thoracic duct or its tributaries. Persistent chyle loss may result in respiratory compromise, nutritional depletion, electrolyte disturbances, and immunosuppression. Diagnosis can be challenging because the initial pleural collection may resemble a traumatic hemothorax before drainage. Case presentation: A previously healthy 40-year-old man presented 3 days after a high-impact road traffic accident with progressive dyspnea, right-sided chest pain, and mid-back pain. At a peripheral facility, chest radiography demonstrated a right pleural effusion, and a tube thoracostomy was performed that initially drained blood, followed by milky fluid. On admission, computed tomography demonstrated a large right pleural effusion, right lower-lobe collapse, a small pneumothorax, and a T10 vertebral teardrop fracture. A repeat tube thoracostomy drained 1200 mL of milky fluid. Pleural fluid analysis revealed lymphocyte predominance, triglycerides of 240 mg/dL, and the presence of chylomicrons, confirming chylothorax. The patient was managed conservatively with chest drainage, fat-free nutritional therapy, total parenteral nutrition, analgesia, and octreotide. Initial drainage remained at 1000–1200 mL/day but subsequently declined to 400 mL/day by day 10 and below 50 mL/day by days 13–15. The chest tube was removed on day 16 following radiographic resolution. Discussion: This case highlights that traumatic chylothorax following thoracic vertebral injury is rare. This case demonstrates that timely diagnosis, multidisciplinary care, and conservative management with chest drainage and nutritional modification can achieve successful resolution without surgery. Conservative treatment remains a viable first-line option in selected patients, particularly in resource-limited settings. Conclusion: High-output traumatic chylothorax can occasionally resolve with conservative management despite an initially high drainage volume. Early recognition, biochemical confirmation, adequate drainage, nutritional support, and close monitoring may permit successful non-operative treatment, particularly where advanced lymphatic interventions are unavailable.