Use of Pleuroperitoneal Shunt in Chylothorax Related to Central Line Associated Thrombosis in Sickle Cell Disease

Abstract

Central vein thrombosis as a cause of chylothorax is uncommon, and in a few cases in the literature was related to thrombotic complications of central venous access devices (CVAD). Superior vena cava (SVC) occlusion-induced chylothorax has been described in adult sickle cell disease (SCD) in a setting of chronic indwelling CVAD. There are limited reports on chylothorax induced by central venous thrombosis secondary to chronic CVAD in children with SCD. We describe an 8-year-old male patient, with a history of SCD, maintained on long term erythrocytapheresis for primary prevention of stroke, and whose clinical course was complicated by chylothorax which was successfully treated with a pleuroperitoneal shunt.

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

“…[49], [51-52], [54-58], [60-64], [66], [70][71][72][73][74][75][76][77][78][79][80][81], [84][85][86][87][88], [90][91][92][93], [95][96][97][98][99][100][101][102][103].…”

“…They include mucosal atrophy of the digestive tract, a decrease in hormone secretion in the digestive tract, and liver dysfunction [94]. Less common methods of nutritional treatment include low-fat diet (2.6 % patients [32], [38], [44], [49], [54], [57], [61], [92], [95], [96]), completely fat-free diet (5,8 % [13], [14], [20], [46], [51], [73], [75], [76], [97], [98]) or in infants -milk with modified fat content (7,5 % [3], [23], [84]). At the same time, authors of many publications do not provide specific diet modifications (10,9 %) [22], [26], [29], [31], [42], [60], [66], [70], [73], [80], [86], [99], [100].…”

“…Treatment with somatostatin or octreotide has been implemented in more than half of the patients from the reviewed literature, in addition to dietary modifications (56,3%) and it achieved a desired therapeutic effect in 63.2 % of them. [2-3], [11][12], [17], [19][20], [25]- [28], [31]- [33], [37], [39], [41]- [43], [45], [52], [54]-[57], [62]- [64], [66], [70][71], [73], [77]- [80], [84], [86][87], [91][92], [95][96], [98], [103] Due to certain differences in pharmacokinetic properties and route of administration, octreotide is a more popular choice (79,9 % of patients) than somatostatin (10,4 %) [3], [11][12], [17], [19][20], [25]- [27], [31][32][33], [37], [39], [41]- [43], [45], [52],...…”

“…Intravenous steroids are also frequently administered in order to reduce inflammation [19], [25], [32], [62], [72], [79], [80], [84], [87], [103]. Antithrombotic prophylaxis, involving heparin -mainly low molecular weight heparin, enoxaparin [71], [72], [95]. Sirolimus is a less commonly used medication [31] One of the elements of the conservative treatment for chylothorax is thoracentesis or chest drain, which allows for a quick removal of fluid from the pleural cavity, but most importantly it allows for a confirmation of the pleural effusion diagnosis.…”

Chylothorax in the neonate—A stepwise approach algorithm

“…Pleuroperitoneal shunts have been described since 1983 in neonates and small infants up to 3 months of age, with weights between 800 and 3300 g 109–112 . The procedure appears to be effective, safe, easy to perform, and well‐tolerated by the patient.…”