அதிர்ச்சி மற்றும் சிகிச்சை இதழ்

Chylothorax due to Blunt Torso Trauma: A Rare Etiology

Abstract

Annu Babu, Amulya Rattan, Piyush Ranjan, Subodh Kumar and Amit Gupta

Chylothorax most commonly occurs after thoracic surgery; blunt thoracic trauma is a rare cause of chylothorax. A 50yr old female presented to our emergency department with history of road traffic injury. On primary assessment the vital parameters were normal and she had a laceration of nasal bridge and lip, with fractures of nasal and right forearm bones. CT scan confirmed fracture of nasal bone, spinous process of D4 vertebrae and bilateral radius. Repair of lip laceration along with open reduction and internal fixation (ORIF) for bilateral radii and nasal bone fracture were done emergently. Patient was allowed orally after 6 hours and recovery seemed to be uneventful. However, patient started complaining of chest heaviness with difficulty in breathing on second post-operative day. On Ultrasound Chest and CT evaluation a radiological diagnosis of traumatic hydrothorax with mediastinal & retroperitoneal lymphangiectasias was made. Intercostal drains placed bilaterally showed chylothorax. Patient was kept nil per oral and on parenteral nutrition, micronutrient supplementation and adequate analgesia. Empiric antibiotic therapy was started. Intercostal drain output and lipid levels of contents decreased with this regime, gradually enteral fat-restricted diet was started with medium chain triglycerides and patient was allowed full orally from day 6. Chest drain was removed on day 11 and patient discharged on day 12.