Chylothorax and central vein thrombosis, an under‐recognized association: a case series

Kho, Sze Shyang; Tie, Siew Teck; Chan, Swee Kim; Yong, Mei Ching; Chai, Sing Ling; Voon, Pei Jye

doi:10.1002/rcr2.221

Cited by 17 publications

(14 citation statements)

References 15 publications

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“…Chylothorax is the accumulation of lymphatic fluid in the pleural cavity ( 1 ). Common causes include direct injury of the thoracic duct after surgery or the infiltration of the lymphatic systemic secondary to malignant disease, whereas SVC obstruction represents a rare cause ( 2 , 3 , 4 ). Chylothorax is a frequent complication of CHD surgery, occurring in about 1% to 9% ( 5 ), increasing morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax Due to Superior Vena Cava Obstruction in a Patient With Complex Congenital Heart Disease

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Chylothorax Due to Superior Vena Cava Obstruction in a Patient With Complex Congenital Heart Disease

et al. 2021

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“…In our review of the literature, we only identified five cases of transudative chylothoraces in the setting of SVC syndrome , [[8], [9], [10], [11]]. This number is limited by the fact that a majority of the ten cases of chylothorax associated with SVC syndrome do not have PFA detailed in the reports.…”

Section: Discussionmentioning

confidence: 99%

A transudative chylothorax associated with superior vena cava syndrome

Austin

Al-Faris

Modi

et al. 2019

Respiratory Medicine Case Reports

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The chylothorax is a lymphocyte predominant protein-discordant exudative pleural effusions with low lactate dehydrogenase and elevated triglyceride levels. Transudative chylothoraces associated with Superior Cava syndrome (SVC) are an extremely rare clinical entity. In this manuscript, we describe a case of transudative chylothorax due to SVC obstruction secondary to thrombosis of a peripheral inserted central venous catheter, which ultimately resolved after endovascular intervention. In our review of the literature, only five cases of transudative chylothorax associated with SVC syndrome were identified with 60% of cases associated with thrombosis and complications due to catheters in the central venous circulation. Treatment of the underlying cause is key to resolution of the chylothorax. Thoracentesis is an initial intervention for diagnostic and therapeutic purposes. Endovascular intervention is the primary mode of treatment for SVC thrombosis and stenting is preferred for malignant causes, however anticoagulation alone has been reported in the resolution of chylothorax. In patients with recurrent chylothorax despite of relief of SVC obstruction, a medium-chain triglyceride diet and octreotide can be prescribed in order to decrease the chyle flow in the thoracic duct. Surgical ligation of the thoracic duct can be considered if medical management and endovascular treatment fails.

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“…Eventually, malignancy-related DVT of the left subclavian/brachiocephalic vein was identified as the possible etiology for the bilateral chylothorax. A deep vein thrombosis of the left subclavian vein can lead to pressure in return of the thoracic duct, which can cause leakage into the pleural space [18]. The thoracic duct will drain into the left side of the neck 92-95% of the time, with the final termination site varying between the left subclavian vein and internal jugular vein junction, the internal jugular vein, the external jugular vein, and subclavian vein [19].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Chylothorax as a Unique Presentation of Pancreaticobiliary or Upper Gastrointestinal Cancer

Merza

Lung

Saadaldin

et al. 2019

Case Reports in Pulmonology

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Chylothorax presents as exudate with lymphocytic predominance and high triglyceride-low LDH levels, usually due to a traumatic disruption of the thoracic duct, possibly iatrogenic. Other causes include malignancy, sarcoidosis, goiter, AIDS, or tuberculosis. Here we present a case of a 66-year-old male who came in with cough and shortness of breath for few weeks. A week earlier, at an ED visit, he was diagnosed with pneumonia based on CT angiogram of the chest without contrast that showed bilateral pleural effusion and bilateral pulmonary infiltrates. The CT-guided placement of bilateral chest tube drained 1160 cc of creamy yellow fluid on the right and 1200 cc of creamy yellow fluid on the left. CT chest/abdomen/pelvis showed bilateral ground-glass opacities within the lungs and possible bony metastasis. A whole-body bone scan showed multiple bony metastatic lesions throughout the skeleton. IR guided bone biopsy suggested upper GI or pancreaticobiliary cancer. Venous ultrasound with Doppler of left upper extremity showed findings suggestive of a nonocclusive DVT of proximal/mid left subclavian vein which is difficult to compress. Eventually, malignancy-related DVT of the left subclavian/brachiocephalic vein was identified as the possible etiology for the bilateral chylothorax.

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Chylothorax and central vein thrombosis, an under‐recognized association: a case series

Cited by 17 publications

References 15 publications

Chylothorax Due to Superior Vena Cava Obstruction in a Patient With Complex Congenital Heart Disease

Chylothorax Due to Superior Vena Cava Obstruction in a Patient With Complex Congenital Heart Disease

A transudative chylothorax associated with superior vena cava syndrome

Bilateral Chylothorax as a Unique Presentation of Pancreaticobiliary or Upper Gastrointestinal Cancer

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