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[A case of chylothorax in which thoracoscopy under local anesthesia and thoracic duct scintigraphy were useful to locate the leakage site].

BACKGROUND
Detailed investigation of the cause of chylothorax and its treatment should be performed by thoracoscopy under general anesthesia, but if this is difficult due to multiple complications it is possible to perform a detailed investigation by combining thoracoscopy under local anesthesia and thoracic duct scintigraphy.


CASE PRESENTATION
A 74-year-old woman presented with exertional dyspnea. Chest X-ray films showed right pleural effusion, and thoracocentesis yielded a milky white pleural effusion, meeting the criteria of chylothorax, after excluding conditions such as malignant lymphoma, amyloidosis and trauma. Since the patient's medical history included pacemaker insertion, dialysis and diabetes, thoracoscopy was performed under local anesthesia rather than general anesthesia, to investigate the cause in detail. The pleural cavity was visualized, but no obvious tumor or other cause was present in the parietal pleura. There was partial adhesion of the lower lobe and chest wall, and the leakage of a milky white pleural effusion from this site was confirmed. We then performed thoracic duct scintigraphy, which revealed an area of enhancement corresponding to the leakage site near the right pulmonary hilum.


CONCLUSION
We describe a case in which thoracoscopy under local anesthesia and thoracic duct scintigraphy were useful for determining the leakage site in chylothorax.