CTICasesIatrogenic Chylothorax and Extrapleural Chyloma after First Rib Resection
Imaging findings
Post-operative radiographs in a patient who underwent resection of the first rib and a cervical rib for thoracic outlet syndrome demonstrate a surgical drain and a small amount of residual gas. Subsequent imaging later that day and the following day shows rapid accumulation of a large extrapleural fluid collection and a localized pneumothorax. Placement of a drain in this extrapleural collection returned chylous fluid, confirming an extrapleural chyloma and associated chylothorax.
Key takeaways
Surgeries for thoracic outlet syndrome, such as first rib or cervical rib resections, are performed in a highly constrained anatomic region closely adjacent to the brachial plexus, subclavian vessels, apical pleura, and the thoracic duct. Injury to the thoracic duct or lymphatic channels near the confluence of the subclavian and internal jugular veins can lead to iatrogenic extrapleural chyloma and chylothorax, which are typically managed conservatively.
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