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We present a rare case of a chylothorax in a 60-year-old patient after resection of the thymus (myasthenia gravis and thymus hyperplasia). A left-sided chylothorax developed 20 days after the resection with an estimated daily fluid loss of 1.7 l. Chest lymphoscintigraphy was performed in the anterior and posterior position 60 min after injection of 4×74 MBq Tc filtered sulphur colloid subcutaneously into the first interdigital space and the retromalleolar space of both feet. The images showed abnormal tracer accumulation in the left hemithorax, as seen on the posterior chest lymphoscintigraphic image. SPECT/CT (Symbia T2 Siemens Medical) of the thorax showed abnormal mediastinal tracer accumulation between the left common carotid artery and the left subclavian artery, suggesting rupture of a collateral thoracic lymph duct. Successful ligation of a ruptured ectopic thoracic duct, situated ventral to the left subclavian artery and the phrenic nerve, by video-assisted thoracoscopic surgery was performed and achieved control of the chylothorax. This case clearly illustrates the added value of SPECT/ CT in addition to lymphoscintigraphy for the anatomical location of a traumatic rupture of a thoracic lymph duct. To our knowledge only a few case reports have been published on this subject [1–4].

Lymphoscintigraphy and SPECT/CT using 99mTc filtered sulphur colloid in chylothorax