Thoracic duct injury after AO C thoracic spine fracture: A case report

Purpose: To describe the rare complication of traumatic thoracic duct injury associated significant thoracic spine fractures and describe treatment when conservative treatment is refractory. Results: A 27-year-old male was admitted to the hospital after a motorcycle collision with a three-column extension injury of spinal levels T9-10 and a traumatic thoracic duct injury that was clinically detected on hospital day 9. This case reports documents successful management of a traumatic chylothorax via thoracic duct embolization. Thoracic duct injury is a rare sequela of vertebral fractures. Drainage and observation is considered first line treatment of a chylothorax. However, surgery is indicated if leakage persists after parenteral feeding and a strict non-fat diet for 5–7 days. This case represents a unique instance where a traumatic spine injury was seen in association with thoracic duct injury and chylothorax. Conclusions: Traumatic thoracic duct injury can occur with significant thoracic spine injuries. Being aware of this potential concomitant injury will prevent a delayed or missed diagnosis. Despite literature that shows that this can be managed conservatively, there are circumstances such as our case where treatment is refractory to non-procedural management. Our case is unique in its description of management in regards to minimally invasive approach to traumatic thoracic duct injury in the context of a spinal fracture.