Pseudochylothorax and diaphragmatic weakness secondary to a misplaced central venous catheter

Puttagunta, Hari Krishna; Seneviratne, Chanaka; Kupfer, Yizhak; Tessler, Sidney

doi:10.1136/bcr-2013-008765

Cited by 7 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sixty-two studies (2,3,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) involving 104 patients were selected for review (51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66). Figure 1 presents a flowchart for the complete breakdown in the identification of appropriate studies corresponding to isolated case reports and a retrospective series (35).…”

Section: Resultsmentioning

confidence: 99%

Characteristics of patients with pseudochylothorax—a systematic review

Lama¹,

Ferreiro²,

Toubes³

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory disorders. Nevertheless, the characteristics of patients with PCT are poorly defined.Methods: A systematic review was performed across two electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of PCT. Case descriptions and retrospective studies were included.Results: The review consisted of 62 studies with a total of 104 patients. Median age was 58 years, the male/ female ratio was 2.6/1, and in the 88.5% of cases the etiology was tuberculosis (TB) or rheumatoid arthritis (RA). PE was usually unilateral (88%) and occupied greater than one-third of the hemithorax (96.3%). There was no evidence of pleural thickening in 20.6% of patients, and 14 patients had a previous PE. The pleural fluid (PF) was an exudate, usually milky (94%) and with a predominance of lymphocytes (61.1%). The most sensitive tests to establish the diagnosis were the cholesterol/triglycerides ratio (CHOL/TG ratio) >1, and the presence of cholesterol crystals (97.4% and 89.7%, respectively). PF culture for TB was positive in the 34.1% of patients. Favorable outcomes with medical treatment, therapeutic thoracentesis, decortication/ pleurectomy, pleurodesis, thoracic drainage and thoracoscopic drainage were achieved in 78.9%, 47.8%, 86.7%, 66.6%, 37.5% and 42.9%, respectively.Conclusions: PCT is usually tuberculous or rheumatoid, unilateral and the PF is a milky exudate. The presence of cholesterol crystals and a CHOL/TG ratio >1 are the most sensitive test for the diagnosis. The lack of pleural thickening does not rule out PCT. Treatment should be sequential, treating the underlying causes, and assessing the need for interventional techniques.

show abstract

Section: Resultsmentioning

confidence: 99%

Characteristics of patients with pseudochylothorax—a systematic review

Lama¹,

Ferreiro²,

Toubes³

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…reported propofol infusion going into the pleural space through a misplaced CVC. [ 9 ] In our case, the aspirate was far more than the amount of propofol used (20 ml of 1% propofol).…”

Section: Discussionmentioning

confidence: 71%

Postoperative chylothorax of unclear etiology in a patient with right-sided subclavian central venous catheter placement

Asghar

Shamim

2017

Anesth Essays Res

View full text Add to dashboard Cite

A young male underwent decompressive craniotomy for an intracerebral bleed. A right-sided subclavian central venous catheter was placed in the operating room after induction of anesthesia. Postoperatively, he was shifted to Intensive Care Unit (ICU) for mechanical ventilation due to low Glasgow coma scale. He had an episode of severe agitation and straining on the tracheal tube in the evening same day. On the 2nd postoperative day in ICU, his airway pressures were high, and chest X-ray revealed massive pleural effusion on right side. Under ultrasound guidance, 1400 milky white fluid was aspirated. It was sent for analysis (triglycerides) that confirmed chyle and hence, chylothorax was made as diagnosis. A duplex scan was done which ruled out thrombosis in subclavian vein. The catheter had normal pressure tracing with free aspiration of blood from all ports. Enteral feeding was continued as it is a controversial matter in the literature and he was monitored clinically and radiologically.

show abstract

“…1 Rare case reports in the human literature comment on the development of lactescent thoracic fluid in patients receiving propofol. [1][2][3][4] In most cases, this substance qualified as chyle, the chylomicron-rich fluid of the lymphatic system, by exceeding the triglyceride concentration threshold value of 110 mg/dL used in human medicine. [1][2][3][4] One human case closely matches the development of thoracic fluid in our patient, in which a central venous catheter was misplaced with subsequent propofol infusion into the pleural space.…”

Section: Discussionmentioning

confidence: 99%