Case Presentation
The patient is a 62-year-old male who presented with cervical spinal
disk disease. He underwent repair via anterior cervical disc fusion
(ACDF). Four months later he presented with neck pain and swelling. Exam
showed indurated and erythematous left neck and upper chest skin.
Imaging showed a 4x4 cm left lower cervical abscess. He underwent
transcervical incision and drainage (Figure 1). A JP drain was placed at
that time. This drain had >1000 cc of cloudy output per
day. ENT was consulted. The drainage was felt to be chyle (Figure 4).
The patient was taken back to the OR with ENT and thoracic surgery
following CT that showed a fluid-filled cavity with a capsule (Figures
2, 3). This capsule, ultimately determined to be a chyloma, was felt to
have walled itself off. As this capsule was opened, copious chyle was
released. The thoracic duct was noted inferior and lateral to the
subclavian vein. This was ligated in the chest. Another JP drain was
placed. The drain was observed postoperatively, and no further chyle
leak was noted. The drain was removed after 5 days. He returned to a
regular diet and had no further issues.