Chylothorax: a rare complication of tube thoracostomy.

Background: Chylothorax resulting from chest tube injury to the thoracic duct is very rare and underreported.

Objective: The purpose of this case report is to exemplify this rare but potentially significant complication of chest tube thoracostomy.

Methods: An 86-year-old woman presented with sepsis and a massive right pleural effusion; she developed a chylous effusion with the pleural fluid triglyceride level of 158 mg/dL 2 days after a traumatic chest tube insertion. All investigations excluded common causes of non-traumatic chylothorax. The chylothorax improved after fasting and implementation of a medium-chain triglyceride diet.

Conclusions: The optimal depth of insertion of the chest tube typically ranges from 5 to 15 cm, ensuring all sideports are within the chest and the proximal port is at least 2 cm beyond the rib margin. Traumatic chylothorax secondary to chest tube insertion should be included in the differential diagnosis of patients presenting with chylothorax after a thoracostomy tube.