Chylothorax is a rare disease with a variety of causes. In most cases, an initial conservative therapy attempt is indicated, with success mainly depending on the amount of leakage. Lymphography alone can be justified as a therapy attempt in individual cases; however, the results are not easily predictable, and it can take several weeks for any therapeutic success to occur. Therefore, other measures are preferred in urgent situations. There are therapy failures in surgical and percutaneous interventions for duct closure. In many cases, surgical and interventional therapy options are complementary. In specialised centres with interventional expertise in thoracic duct embolisation, an interventional approach is now preferred as the first measure over surgical procedures, as the morbidity and mortality associated with the method are lower. Surgical therapy failures should, in any case, be referred to a specialised interventional centre.