Introduction: Thoracic duct rupture is an uncommon presentation and usually occurs through trauma or surgery.
Case presentation: Here, we present an entirely unique case of recurrent spontaneous thoracic duct rupture in a 34-year-old woman who had three separate episodes of thoracic duct rupture. The first two episodes appear to have been caused by a spontaneous internal jugular vein (IJV) thrombosis whereas the final had no demonstrable cause. The initial presentation was with neck swelling, the second with chylothorax.
Management and outcome: This patient was treated with rivaroxaban for the IJV thrombosis while her chylothorax was treated conservatively.
Discussion: This case serves as a learning pearl to consider thoracic duct rupture in patients with neck swellings even without apparent traumatic or iatrogenic cause. It also brings to light the idea of previous insults weakening thoracic duct rupture and predisposing patients to recurrent issues.
Connerley M, Zorn G. Chylothorax due to spontaneous rupture of the thoracic duct. US Armed Forces Med J 1955;6(1):51–59. PMID: 13226562.
McGrath EE, Blades Z, Anderson PB. Chylothorax: Aetiology, diagnosis and therapeutic options. Respir Med 2010;104(1):1–8. DOI: 10.1016/j.rmed.2009.08.010.
Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 2007;32(2):362–369. DOI: 10.1016/j.ejcts.2007.04.024.
Schild HH, Strassburg CP, Welz A, et al. Treatment options in patients with chylothorax. Dtsch Arztebl Int 2013;110(48):819–826. DOI: 10.3238/arztebl.2013.0819.
Varache N, Bouachour G, Le Davay M, et al. Bilateral chylothorax following jugular catheterization in a woman with complete situs inversus. Am J Emerg Med 1991;9(3):235–236. DOI: 10.1016/0735-6757(91)90084-w.
Hsu LH, Lien TC, Wang JH. Chylothorax: A complication of internal jugular vein catheterization. Zhonghua Yi Xue Za Zhi (Taipei) 1997;60(1):57–61. PMID: 9316330.
Valassiadou K, Prinianakis G, Sanidas E, et al. Milky-white pleural effusion in a patient with acute respiratory failure: A case report. Intensive Care Med 2000;26(5):645–646. DOI: 10.1007/s001340051220.
Schummer W, Schummer C, Hoffmann E. [Chylothorax after central venous catheterization. Considerations to anatomy, differential diagnosis and therapy]. Anaesthesist 2003;52(10):919–924. DOI: 10.1007/s00101-003-0544-5.
Beljaars GH, Van Schil P, De Weerdt A, et al. Chylothorax, an unusual mechanical complication after central venous cannulation in children. Eur J Pediatr 2006;165(9):646–647. DOI: 10.1007/s00431-006-0145-9.
Doerr CH, Allen MS, Nichols III FC, et al. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005;80(7):867–870. DOI: 10.4065/80.7.867.
