Chylothorax is a condition that is debilitating to the point of threatening life. There is controversy over its management, in particular the relative merits of conservative measures and the timing of surgical intervention.The literature is reviewed from the basic sciences of chyle composition and flow, to diagnostic approaches, the complications of chyle loss and appropriate management strategies.Prompt diagnosis is essential to institute an effective therapeutic regimen. Surgery achieves fast, safe and effective reversal of this dire situation. Minimally invasive thoracoscopic techniques are gaining wide recognition. Early intervention, which should be aggressive and complete to avoid the immune and nutritional consequences of extended chyle depletion, is recommended.