Spontaneous Metachronous Chylothorax—Presenting As a Neck Lump

Chylothorax is defined as an accumulation of chylecontaining lymphatic fluid within the pleural space. Most adult chylothoraces are related to surgery or malignancy. Spontaneous idiopathic chylothorax in adults is an extremely rare occurrence with very few reported cases. We present the first described case of spontaneous metachronous chylothorax presenting as a neck lump in a 48-year-old Caucasian female and its associated workup, diagnosis, and management. It is an extremely rare condition and efforts should be made at excluding more common causes of pleural effusion in adults. Definitive diagnosis should be made through thoracocentesis and fluid analysis. Its management remains variable however conservative management is usually advocated as first line therapy.