Chylothorax and Chylopericardial Tamponade in a Hemodialysis Patient with Catheter‐Induced Superior Vena Cava Stenosis

Abstract

Chylothorax and chylopericardium refer to the presence of milky, triglyceride-rich chylous fluid in the thoracic and pericardial spaces, respectively. Both conditions are extremely uncommon in end-stage renal disease patients on dialysis. We report the first known case of combined chylothorax and chylous pericardial tamponade in a dialysis patient associated with catheter-induced superior vena cava (SVC) stenosis. A successful outcome was achieved with drainage of both chylous effusions in combination with angioplasty of the SVC stenosis.

Chylopericardium and chylothorax: Unusual mechanical complications of central venous catheters

“…In the present case, there was an increase in the central venous pressure due to thrombosis and stenosis. This elevated pressure led to an increase in the thoracic duct luminal pressure and subsequently chyle leakage from pleural and pericardial lymphatics causing the chylopericardium and chylothorax 5 . The previous indwelling line was probably the major factor for thrombosis in the present patient, but patients can have hypercoagulability following allogenic HSC transplant 6 .…”

Obstruction of the Superior Vena Cava After Neonatal Extracorporeal Membrane Oxygenation

“…In 1936, Blalock et al (19) reported chylothorax in response to SVC occlusion in dogs. Since that time, a number of studies have described chylothorax after SVC obstruction (20)(21)(22)(23). Patients who undergo cardiac or thoracic surgery and ECMO may be at risk for the first two mechanisms.…”

A case of chylothorax in a hemodialysis patient with left innominate venous stenosis

“…[1] Chylothorax can be left-sided (33.3%) when due to damage above the fifth thoracic vertebra, right-sided (50%) when due to thoracic duct damage below this level, or bilateral (16.7%). [2] Other causes include malignancy, cardiac failure, sarcoidosis, goiter, as well as thoracic and upper gastrointestinal surgery.…”