Abstract Introduction Chylothorax is a rare but clinically significant complication of thoracic surgery, resulting from disruption of the thoracic duct or its tributaries. While most cases occur in the early postoperative period, delayed presentations are unusual. With the increasing use of robotic-assisted approaches for pulmonary resections and lymph node dissections, recognition of potential complications is critical. Case An 82-year-old male with a history of diabetes, liver cirrhosis, chronic obstructive pulmonary disease, and recent robotic-assisted right upper lobectomy with mediastinal lymph node dissection for squamous cell carcinoma presented to the emergency department after a fall. He was hypoxic (SpO2 88% on room air) and hypotensive (80/67 mmHg). Laboratory results showed leukocytosis (18.6 × 109/L), hyponatremia (131 mmol/L), elevated liver enzymes (AST 187 U/L, ALT 196 U/L, alkaline phosphatase 1834 U/L), BNP 1967 pg/mL, and lactate 2.4 mmol/L. Chest radiograph demonstrated complete opacification of the right hemithorax.The patient was admitted to the ICU for septic shock and hypoxemic respiratory failure. CT imaging revealed a large right hydropneumothorax with right lung compression and right lower lobe consolidation. Chest tube placement drained 1.4 L of milky fluid. Pleural fluid analysis revealed glucose 223 mg/dL, protein 2.5 g/dL, triglycerides 108 mg/dL, and WBC 309/µL (80% lymphocytes). Cytology and cultures were negative. Findings were consistent with chylothorax. Given his recent thoracic surgery, a diagnosis of delayed iatrogenic chylothorax was established. The patient was managed with chest tube drainage, broad-spectrum antibiotics, and critical care support. Discussion This case highlights a rare delayed presentation of iatrogenic chylothorax occurring two months after robotic mediastinal lymph node dissection. Although most chylothoraces occur in the immediate postoperative period, clinicians should maintain a high index of suspicion for new pleural effusions in post-thoracic surgery patients, even weeks after surgery. Early recognition and appropriate management are essential to reduce morbidity and improve outcomes. This abstract is funded by: none
Pominov et al. (Fri,) studied this question.