A 15- year-old boy was referred to Imam Reza Hospital with a right
chest tube and
chylothorax for 40 days. The patient had respiratory distress and undergone refractory treatment for
chylothorax. The fluid content was chyle-rich in
lipids. Computed Tomography of the chest showed a large, incompletely evacuated
cyst in the left posterior mediastinum with left
pleural effusion. The
cyst could not be resected through right
thoracotomy, because of the left side location of the
cyst.
Ligation of the thoracic duct through right
thoracotomy was not effective in reducing chylous effusion 4 days later. Left
chylothorax exacerbated because of the complication of right
thoracotomy. Laparatomy was performed to ligate the thoracic duct 6 days later. On exploratory laparatomy, chylous effusion was detected in the peritoneum. Thoracic duct with all the fibro-fatty tissues was ligated below the diaphragm over the spine at 12(th) to 2(nd) vertebral spaces. Right
chylothorax was resolved after
ligation of thoracic duct transabdominally 1-2 days later. Left chylous effusion was decreased and treated 46 days after laparatomy. One year follow up of the patient showed excellent result. In our knowledge, thoracic duct
cyst occurring as a result of a delayed
chylothorax and
chyloperitoneum has not been reported in the literature. Surgical thoracic duct
ligation can be the treatment of choice.