Pathogenesis of bilateral chylothorax after injury of thoracic duct during central venous catheterization

[...]the increasing hydrostatic pressure within the thoracic duct proximal to the occluding site, along with the intrapleural negativity (the pleural space being adjacent to the mediastinum), leads to the transudation of chyle [3] into the mediastinal space [Figure 2].Following collection into the mediastinum, the chyle flows into the pleural spaces in the following ways:[4]Rupture of the mediastinal pleura due to accumulation of chyle under tension in the mediastinumSipping into the pleural spaces by maceration or backflow through intrapulmonary lymphaticsSuction of chyle into the pleural spaces by the intrapleural negativityHowever, systematic literature search by the authors reveal cases where contralateral chylothorax has resulted after injury of the thoracic duct/right lymphatic duct.