Iatrogenic traumatic chylothorax complicates up to 4% of esophageal resections [1,2,4-7]. Lung cancer resections, cardiovascular surgeries, and Chylothorax Treatment Planning spinal surgeries can also be complicated by chylothorax, although at a lesser rate. Noniatrogenic causes of traumatic chylothorax include penetrating trauma, fracture-dislocation of the spine, and hyperflexion injuries [1,6,7]. Generally, the causative etiology is known in the traumatic setting. Sampling the pleural effusion confirms the diagnosis of chylothorax. Imaging a patient with a known traumatic chylothorax serves only to confirm the diagnosis and assist in therapeutic planning. Chest radiography In the setting of a traumatic injury to the thoracic duct, most commonly postoperative or mechanical trauma, chest radiographs can confirm the presence of pleural fluid and lateralize the process and are routinely acquired in the daily evaluation of supportive lines and tubes [19]. Ultrasound US can be helpful in the guidance of thoracentesis and intranodal injection during lymphangiography [21]. Otherwise, US has little, if any, diagnostic role in the setting of a known traumatic chylothorax. Conventional lymphangiography Conventional lymphangiography is the gold standard for visualization of lymph nodes, lymphatic vessels, cisterna chyli, the thoracic duct, and sites of injury [14,22,23]. Lymphangiography alone has been shown to be therapeutic in a small percentage of patients, irrespective of attempts at TDE or disruption [24-27]. When performed as a prelude to TDE, the combination is particularly effective in treating traumatic chylothorax, with technical and clinical success rates approaching 90% [5-9,11]. Nuclear lymphoscintigraphy Although nuclear lymphoscintigraphy may be able to confirm a lymphatic leak and identify the site, little evidence is present to support its routine use [31-33].
Chylothorax Treatment Planning. Iatrogenic traumatic chylothorax complicates up to 4% of esophageal resections [1,2,4-7]. Lung cancer resections, cardiovascular surgeries, and Chylothorax Treatment Planning spinal surgeries can also be complicated by chylothorax, although at a lesser rate. Noniatrogenic causes of traumatic chylothorax include penetrating trauma, fracture-dislocation of the spine, and hyperflexion injuries [1,6,7]. Generally, the causative etiology is known in the traumatic setting. Sampling the pleural effusion confirms the diagnosis of chylothorax. Imaging a patient with a known traumatic chylothorax serves only to confirm the diagnosis and assist in therapeutic planning. Chest radiography In the setting of a traumatic injury to the thoracic duct, most commonly postoperative or mechanical trauma, chest radiographs can confirm the presence of pleural fluid and lateralize the process and are routinely acquired in the daily evaluation of supportive lines and tubes [19]. Ultrasound US can be helpful in the guidance of thoracentesis and intranodal injection during lymphangiography [21]. Otherwise, US has little, if any, diagnostic role in the setting of a known traumatic chylothorax. Conventional lymphangiography Conventional lymphangiography is the gold standard for visualization of lymph nodes, lymphatic vessels, cisterna chyli, the thoracic duct, and sites of injury [14,22,23]. Lymphangiography alone has been shown to be therapeutic in a small percentage of patients, irrespective of attempts at TDE or disruption [24-27]. When performed as a prelude to TDE, the combination is particularly effective in treating traumatic chylothorax, with technical and clinical success rates approaching 90% [5-9,11]. Nuclear lymphoscintigraphy Although nuclear lymphoscintigraphy may be able to confirm a lymphatic leak and identify the site, little evidence is present to support its routine use [31-33].