Abstract
A 65-year-old man underwent right upper lobectomy and lymph node dissection (ND2a) for cancer of the right lung. On the first postoperative day, a milky-white pleural effusion was observed after the patient had lunch. He was diagnosed with chylothorax. He was subsequently placed on a fat-restricted diet, being allowed only medium-chain fatty acids, and received pleurodesis using OK-432. However, there was no reduction of pleural effusion. On the 25th postoperative day, lymphangiography was performed. The thoracic duct changed its course near the tracheal bifurcation and ran an aberrant course toward the right venous angle. The main thoracic duct was interrupted at the apex of the thoracic cavity, and the leakage of lipiodol was observed. Ligation of the thoracic duct was performed on the 32nd postoperative day based on lymphangiographic findings. Chylothorax improved soon after surgery. Lymphangiography confirmed an aberrant course of the thoracic duct and an injured site. Lymphangiography was very useful in ligation of the thoracic duct. We report herein this case with a review of the literature.
