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After malignancy, traumatic and surgical injuries to the upper abdomen and chest are the leading causes of chylothorax. Thoracic spine extension injury, blunt or penetrating chest trauma, anterior thoracic spine surgery, and increased intra-abdominal pressure have all been implicated in the development of chylothorax. Despite the physiatrist's frequent exposure to polytrauma and postsurgical patients, there are no case reports of chylothorax complicating inpatient rehabilitation or occurring in a patient fitted in a thoracic or lumbar orthosis. We present the case of a patient with traumatic spinal cord injury from a high-speed motor vehicle accident who was diagnosed with a left-sided chylothorax while wearing a thoracolumbosacral orthosis 4 wks into her inpatient rehabilitation stay. Knowledge of the anatomy of the thoracic duct can be useful for diagnosing chylothorax in patients with thoracic spine fractures, upper abdomen/chest injury, or thoracic surgery, as the trajectory of the duct often determines the location of pleural effusion.