Chylothorax following Innominate Vein Thrombosis: A Rare Complication of Transvenous Pacemaker Implantation

Abstract

A case of chylothorax following innominate vein thrombosis, which developed as a late complication of transvenous pacemaker implantation, is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. The aetiological workup showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge this is the first report of a case of this nature.

Severe Venous and Lymphatic Obstruction after Single-Chamber Pacemaker Implantation in a Patient with Chest Radiation Therapy

“…Typically, the most severe consequence of acute occlusion of the subclavian vein following device implantation is ipsilateral arm edema, which is treated with anticoagulation. Disruption of lymphatic drainage and development of chylothorax following subclavian and/or brachiocephalic vein thrombosis has been a rarely reported complication of central venous cannulation 2–5 . Previous chest irradiation has also been implicated as a cause for chylothorax 6,7 and the effects of chest irradiation on venous structures are well known.…”

“…Disruption of lymphatic drainage and development of chylothorax following subclavian and/or brachiocephalic vein thrombosis has been a rarely reported complication of central venous cannulation. [2][3][4][5] Previous chest irradiation has also been implicated as a cause for chylothorax 6,7 and the effects of chest irradiation on venous structures are well known. We present a case of chylothorax and profound edema that developed subacutely after a single-chamber pacemaker implantation in a Case A 73-year-old woman with paroxysmal atrial fibrillation and sinus node dysfunction was referred for dual-chamber pacemaker implantation because of symptomatic bradycardia with pauses over 5 seconds when in sinus rhythm, as well as insufficient rate control during atrial fibrillation.…”