Chylothorax is an uncommon condition characterized by an accumulation of chylous effusion within the pleural space. A majority of the time, the underlying disorder generating the effusion cannot be characterized. Chylothorax is attributed to either an error with the integrity of the thoracic duct itself (increased permeability, blind ended lymphatics, structural abnormalities of the wall) or due to increased venous pressure. Once all possible etiologies have been eliminated, the diagnosis of idiopathic chylothorax is made. Medical treatment for this condition is generally unrewarding and various surgical options have been attempted with varying success. Through a case study, the emergency presentation, diagnosis, as well as medical and surgical treatment options for chylothorax will be examined in detail with a detailed look at the procedure for thoracic duct ligation.