Chylopericardium and chylothorax: Unusual mechanical complications of central venous catheters

Abstract

Obstruction and thrombosis of major systemic veins can occur due to indwelling central venous catheters. If obstruction of the innominate vein or superior vena cava occurs, lymphatic drainage can be impaired due to an increase in pressure in the thoracic duct and lymphatics. We describe a case where superior vena cava syndrome, chylopericardium and chylothorax occurred in a 16-year-old girl due to an indwelling central venous catheter. This was successfully treated with removal of the line, anticoagulation and angioplasty of the innominate vein and superior vena cava.

Pleural and pericardial effusion: A manifestation of SVC syndrome in a child on chronic hemodialysis

“…Congestive heart failure was ruled out. 3 Eventually, the patient was also found to have significant SVC stenosis. Balloon and stent SVC angioplasty, HD line replacement, and drainage of the pleural effusion lead to the eventual resolution of both the pleural and pericardial effusions.…”

“…Pleural and pericardial effusions may occur secondary to infectious, autoimmune disease and malignancies, and all these were ruled out. Congestive heart failure was ruled out …”

Balloon Angioplasty for the Treatment of Left Innominate Vein Obstruction Related Chylothorax after Congenital Heart Surgery

“…Postoperative chylous effusion management algorithms aimed at identifying deep venous thrombosis (DVT) have been reported; and treatment with heparinization, local/systemic thrombolytics, and thrombectomy have been utilized if DVT is identified . Sparse reports have highlighted the potential benefits of innominate vein and superior vena cava angioplasty to ameliorate chylous effusions after pacemaker implantation and extracorporeal membrane oxygenation . However, there are no data on the utility of angioplasty for left innominate vein obstruction‐associated chylothorax in children and neonates following congenital heart surgery.…”

“…10 Chylous effusion has been associated with left innominate vein obstruction and subsequent impedance to the normal thoracic duct drainage. [11][12][13][14][15][16][17] Postoperative chylous effusion management algorithms aimed at identifying deep venous thrombosis (DVT) have been reported 3,18,19 ; and treatment with heparinization, local/systemic thrombolytics, and thrombectomy Financial support for this study was provided through departmental funds.…”

“…2,3,11,20 Sparse reports have highlighted the potential benefits of innominate vein and superior vena cava angioplasty to ameliorate chylous effusions after pacemaker implantation and extracorporeal membrane oxygenation. [21][22][23][24] However, there are no data on the utility of angioplasty for left innominate vein obstruction-associated chylothorax in children and neonates following congenital heart surgery.…”