PMC9831649_01
(a) Uniport video-assisted thoracic surgery (VATS) right supradiaphragmatic thoracic duct ligation; white broken lines mark the course of the thoracic duct; the single white arrow marks the aorta, the double white arrows mark the azygos vein. (b) Left lateral uniport VATS reveals that the thoracic duct fistula locates at the T2-T3 level; chylous pleural effusion flows from the fistula; the single white arrow marks the thoracic duct fistula; the white broken lines mark the chylous pleural effusion. (c) Magnetic resonance-thoracic discography reveals that the thoracic duct fistula is located at the left posterior part of the esophagus at the T2-T3 level; the single white arrow marks the thoracic duct fistula in the coronal view. (d) The thoracic duct fistula is connected to the pleural effusion in the Axial view; the single white arrow marks the thoracic duct fistula.
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Therefore, she underwent conventional right supradiaphragmatic thoracic duct ligation by uniport VATS (Fig. 1a) But the condition was no improvement, and even developed high-volume, milky pleural fluid drainage >1200 ml/24 h on POD 8. From the coronal view (Fig. 1c) and axial view (Fig. 1d), the relationship between the chylothorax and the thoracic duct fistula was clearly shown. Then she underwent the third operation, ligating the thoracic duct fistula by uniport VATS on POD 19 (Fig. 1b).