Clinical Practice and Cases in Emergency Medicine

Chylothorax represents an uncommon clinical entity with multiple etiologies. Chylothorax following bluntthoracic trauma is typically associated with posterior rib fractures or thoracic vertebral fractures or dislocations.The occurrence of a traumatic chylothorax in the absence of associated injuries is a rare event. We reporta case of a 51-year-old patient who developed bilateral chylothorax after sustaining blunt trauma withoutradiographic evidence of traumatic injury. A 51-year-old male presented to the emergency departmentcomplaining of progressively worsening shortness of breath and associated chest pain for the prior one weekfollowing a fall down several concrete steps. On evaluation, the patient was found to have bilateral pleuraleffusions with no radiographic evidence of traumatic injury, including posterior rib or thoracic vertebral fractures.Subsequent thoracentesis and pleural fluid analysis were performed confirming the diagnosis of chylothorax.Management included repeated thoracentesis, diet modification and octreotide administration, which resultedin dramatic improvement and eventual resolution of symptoms. Non-iatrogenic traumatic bilateral chylothoraxin the absence of other radiographically demonstrated bony or soft tissue injury is a rare event. Chylothoraxshould be considered in the differential diagnosis of patients presenting with chest pain or shortness of breathfollowing blunt trauma and evidence of pleural effusion, even in the absence of obvious traumatic fracture orinjury on radiographic imaging.