title: Delayed right chylothorax after left blunt chest trauma: a case report.
abstract: BACKGROUND
  Chylothorax is a disease that has various causes such as neoplasm, infection, post-surgery trauma, congenital, and venous thrombosis. In approximately 15% of cases of chylothorax, the exact cause is unknown. We report a case of delayed occurrence of right chylothorax in a patient who had multiple segmental ribs fracture on his left side.
  
  
  METHODS
  A 70-year-old Asian man had a "rollover" accident in which the cultivator he was driving overturned. He presented to our hospital with the main complaint of severe dyspnea. On chest computed tomography, multiple ribs fracture from the first to the eighth rib of the left side of his chest and left-sided hemopneumothorax were presented, but there was no evidence of fracture in the right side of his chest. After closed thoracostomy, an emergency operation for open reduction of fractured ribs was performed. On the fifth postoperative day, tubal feeding was performed. On the next day, a plain chest X-ray image showed pleural effusion of the right side of his chest. After insertion of a small-bore chest tube, 3390 ml of fluid for 24 hours was drained. The body fluid analysis revealed triglycerides levels of 1000 mg/dL, which led to a diagnosis of chylothorax. Although non-oral feeding and total parenteral nutrition were sustained, drain amount was increased on the fifth day. Surgical treatment (thoracoscopic thoracic duct ligation and pleurectomy) was performed in the early phase. The right chest tube was removed on the 14th postoperative day after the effusion completely resolved and he was uneventfully discharged.
  
  
  CONCLUSIONS
  In this case, as our patient was in old age and had multiple traumas, surgical treatment for chylothorax needed to be performed in the early phase.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
authors.forename: Jonggeun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea. drmozart@hanmail.net.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea.
authors.forename: Hoseok
authors.initials: H
authors.lastname: I
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, 179 Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea.
authors.forename: Yeong Dae
authors.initials: YD
authors.lastname: Kim
mesh_terms: D000368:Aged; D015505:Chest Tubes; D002916:Chylothorax / Q000175:diagnosis* / Q000601:surgery; D004322:Drainage / Q000295:instrumentation; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis* / Q000628:therapy; D013902:Radiography, Thoracic; D012253:Rib Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D013897:Thoracic Duct / Q000601:surgery; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D013907:Thoracostomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Chest trauma; Chylothorax; Delayed chylothorax; Thoracic duct