Chylous cysts of the mediastinum: report of a case and review of the literature.

Life-threatening spontaneous chylothorax is a rare clinical entity. Correct diagnosis and understanding of its pathogenesis is paramount in order to apply definite surgical treatment. A case of a ruptured multilocular chylocyst around the thoracic duct and cysterna chyli is presented. Multiple bilateral aspirations, right thoracostomy, right thoracotomy, a frustrated attempt to ligate the thoracic duct, and an attempt to insert a pleuroperitoneal shunt, were all unsuccessful. Definite surgery accomplished rehabilitation of the patient after a 5 1/2 month hospitalization. Revision of the literature and vindicative historical facts are presented.