SHM Converge Scientific Abstract ePoster Gallery-The Milky Cascade : Managing Chylothorax After Nephrectomy

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This case describes a 75-year-old woman who developed a left-sided chylothorax after a left radical nephrectomy for renal cell carcinoma. One month after surgery, she presented with worsening left chest and back pain. CT imaging showed a left pleural effusion and a retroperitoneal fluid collection in the left renal fossa. Thoracentesis drained 600 mL of milky pleural fluid, which was exudative and had very high triglycerides (2182 mg/dL) and elevated cholesterol, confirming chylothorax; cytology was negative for malignancy. The retroperitoneal collection was also consistent with chylous fluid, suggesting an iatrogenic lymphatic injury related to surgery.<br /><br />Management included placement of percutaneous drains in both the pleural space and retroperitoneal collection, with close monitoring of output. The patient was treated conservatively with a fat-free diet supplemented by medium-chain fatty acids and octreotide. Because the drainage output decreased and repeat imaging showed no reaccumulation, the drains were removed. Lymphangiography and embolization were not needed. She was discharged on a low-fat diet with medium-chain fatty acids and planned pulmonology follow-up to monitor for recurrence.<br /><br />The discussion emphasizes that chylothorax is an uncommon pleural effusion with both traumatic and non-traumatic causes, with malignancy and thoracic surgery being leading examples. There are no universally accepted evidence-based management guidelines. Treatment depends on cause, output volume, and the patient’s overall condition. Low-output cases may respond to drainage, dietary modification, and somatostatin analogs, while high-output or persistent leaks often require early procedural or surgical intervention.<br /><br />Key learning points: chylothorax has a broad differential, often requires multidisciplinary management, and therapy must be individualized based on clinical factors and local expertise.

Asset Subtitle

Simrat K. Batth

Meta Tag

Author List Simrat K. Batth

Category Clinical Vignettes

Concept Chylothorax

Concept Pleural Fluid

Concept Triglycerides

Concept Chylomicrons

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center NYC H+H

Presenting Author Simrat K. Batth

Track Adult

Keywords

chylothorax

renal cell carcinoma

radical nephrectomy

pleural effusion

chylous fluid

thoracentesis

retroperitoneal collection

octreotide

medium-chain fatty acids

lymphatic injury

Chylothorax

Pleural Fluid

Triglycerides

Chylomicrons

Pleural Effusion