Surgical treatment is not commonly used in the management of chylothorax. We describe a complicated algorithm that we used in treating a 70-year-old lady with Bechterev disease, who suffered from a blunt chest injury with subsequent right-sided serial ribs fracture with hemothorax and thoracic vertebral body fracture. Because of Bechterev disease, hyperextension of the ossified thoracic spine caused an injury of the thoracic lymphatic duct. Simultaneous thoracic spine stabilisation with surgical revision of the thoracic lymphatic duct from an anterior approach was indicated. Despite the urgency of thoracic spine stabilisation, the procedure was postponed due to an acute coronary syndrome, which implied drug eluting stent insertion with a subsequent need of dual anti platelet therapy. Thus, the procedure was done 16 days after stent insertion. The diagnosis of chylotorax must be considered in case of thoracic injury with continuing waste to the chest tube and the finding of well expanded pulmonary parenchyma. Biochemical investigation of the effusion is the cornerstone in establishing the diagnosis of chylothorax (Tab. 2, Fig. 1, Ref. 14).