Chylothorax complicating pulmonary resections is exceptional and manag
ement of this complication remains controversial. We report a case of
chylothorax after a right pneumonectomy and radical subcarinal nodal d
issection. Successful nonoperative management consisted of controlled
tube drainage, fasting, and total parenteral nutritional support for a
period of 2 weeks. A review of the literature reveals 27 other cases
of this complication after intrapleural pneumonectomy: 12 were treated
by conservative measures alone and 15 required surgical intervention.
Factors that will determine the management and the ultimate success o
f conservative management include (1) a relative delay in initial occu
rrence, (2) a decrease in or complete cessation of leakage while recei
ving total parenteral nutrition, and (3) favorable lymphangiographic f
indings.