Chylothorax following partial nephrectomy – A case report of a rare cause of chylothorax
Background Chylothorax, defined as the accumulation of chyle in the pleural space, is a rare but significant cause of pleural effusion. Its causes can be broadly classified into traumatic and non-traumatic, for which majority are from surgeries, most often cardiothoracic surgery, due to damage of th...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2025-07-01
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| Series: | Proceedings of Singapore Healthcare |
| Online Access: | https://doi.org/10.1177/20101058251365299 |
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| Summary: | Background Chylothorax, defined as the accumulation of chyle in the pleural space, is a rare but significant cause of pleural effusion. Its causes can be broadly classified into traumatic and non-traumatic, for which majority are from surgeries, most often cardiothoracic surgery, due to damage of the thoracic duct and its tributaries. Chylothorax after retroperitoneal surgery, such as nephrectomy, is exceptionally rare, and so far has only been reported in a few case reports. Research design Here we present a case of a 67-year-old female with hyperlipidemia who developed chylothorax after an uncomplicated left robot-assisted partial nephrectomy for renal angiomyolipoma. On postoperative day 2 (POD2), she developed pleuritic chest pain and a left-sided pneumothorax, followed by increasing pleural effusion. A chest drain was inserted on POD5, and pleural fluid analysis revealed a chylous effusion with a triglyceride level of 15 mmol/L. The effusion was managed with dietary fat restriction, octreotide therapy, and pleural drainage. The chest drain was removed on POD15 after the drainage volume decreased to <30 mL/day for two consecutive days, and no recurrence was observed. Given the negative clinical, biochemical and imaging features for malignancy and lack of cystic lung disease and low VEGF-D level inconsistent with Lymphangioleiomyomatosis (LAM), nephrectomy was considered the most likely cause for the chylothorax. Conclusion This case highlights the importance of early diagnosis and a multidisciplinary approach in managing postoperative chylothorax, even in rare instances following retroperitoneal surgery. |
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| ISSN: | 2059-2329 |