Chylothorax following apparently spontaneous central venous thrombosis in a patient with septic shock

Abstract

Within the pediatric age group, chylothorax is rare and has been reported almost exclusively in the setting of thoracic surgical procedures or central venous hypertension secondary to central venous catheter thrombosis. We report on the development of central venous thrombosis and chylothorax in the absence of the usual risk factors in a patient with septic shock, and we expand on the role that procoagulant states, such as those induced by sepsis, might play in the development of this complication. This case reminds the practitioner that central venous thromboses and their complications may occur in the absence of the usually reported risk factors and must therefore still be considered when other clinical events suggest their presence.

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“…11,12 Central venous thrombosis and chylothorax may occur in the absence of the usual risk factors-either hereditary thrombophilia or acquired thromboembolic factors-in a patient with septic shock, and procoagulant states such as those induced by sepsis may contribute to the development of chylothorax. 13 In the present patient, oral feeding was associated with marked change in the color and biochemical constituents of the pleural fluid, similar to previously reported findings. 14 Malignancy was excluded with computed tomography and magnetic resonance imaging scans of the chest and abdomen.…”

Cylothorax Developing Due to Thrombosis in The Subclavian Vein

“…In our case, chylothorax related to thrombus was detected approximately on the 34 day. Although venography is the golden standard in subclavian vein thrombosis, Doppler USG can also be used (9). We detected the thrombus non-invasively with doppler USG in our case.…”

Diverticulitis of Cecum Mimicking Plastron Appendicitis: A Diagnostic and Therapeutic Dilemma

“…Even if colon barium graphy can ascertain the diagnosis, this diagnostic modality performed in every cases is hardly due to the fact the clinic in these cases generally mimic that of acute appendicitis, thereby necessitating emergency surgery in most of the cases (8). The definitive diagnosis of cecal diverticulitis is most commonly made clear intra-operatively during exploration for suspected appendicitis (9). We had already suspected from acute plastron appendicitis in our case with no history of prior appendectomy based on the evaluation of nonspecific findings from US and CT together with the clinical findings and laboratory analysis, yet the definitive diagnosis was only established intraoperatively.…”

“…However, debates as to which one of the treatment methods, namely the conservative and radical surgical treatments, remain alive. When the diagnosis is made before the operation, some authors have advocated nonoperative management with antibiotic therapy (9). Furthermore, a conservative treatment can be planned if carcinoma managed to be ruled out or in the absence of widespread inflammation (5).…”