Contralateral Chylothorax after Congenital Diaphragmatic Hernia Repair

On postoperative day 7, the patient was noted to have a worsening right sided pleural effusion (Fig. 2) and chylothorax was diagnosed by thoracentesis and fluid analysis. Because of persistent supplemental oxygen requirement, a thoracostomy tube was inserted on postoperative day 9, and the patient was started on total parenteral nutrition. Complications of untreated chylothorax include cardiopulmonary disturbances in the early setting, and malnutrition or immunosuppression in later stages. [...]early recognition and treatment is prudent. initially, a chest radiograph will demonstrate a pleural effusion with possible atelectasis or mediastinal shift. Most chylothoraces secondary to congenital diaphragmatic hernia (CDH) can be managed with pleural drainage, adequate resuscitation, and parenteral nutrition with reported success rates of 83 per cent.3 Shortand medium-chain fatty acids are absorbed directly into the portal venous system compared with long fatty acid absorption into the lymphatic channels. [...]they are the preferred mode of nutrition to reduce chylous output.