Chylothorax due to central vein thrombosis treated by venous stenting using a dual approach: A case report.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
10 Dec 2021
10 Dec 2021
Historique:
received:
19
10
2021
accepted:
16
11
2021
entrez:
10
12
2021
pubmed:
11
12
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
Central vein thrombosis is an uncommon cause of chylothorax, usually secondary to central venous catheterization in association with prothrombotic state causes such as malignancies. In the following case, thrombosis was located in the left brachiocephalic vein and caused recurrent chylothorax resistant to the first line of treatment and successfully treated by percutaneous recanalization using a dual approach. A 52-year-old male patient with current follicular lymphoma undergoing treatment and recent history of COVID-19 pulmonary infection was hospitalized for dyspnea. A chest X-ray revealed extensive bilateral pleural effusion. Analysis of the pleural fluid was compatible with a chylothorax. Iodin injected thoracic computed tomography (CT) revealed a complete left brachiocephalic thrombosis extending to the left axillary vein, with no thoracic mass. Chylothorax due to left brachiocephalic vein thrombosis. Following an unsuccessful first line of treatment consisting of a low-fat diet, somatostatins and anticoagulation medication, the patient was elected to undergo minimally invasive venous recanalization with stenting. After a first failed attempt of recanalization by femoral access, we successfully crossed the thrombus through brachial access and conducted a dilatation and stenting of the brachiocephalic vein by femoral access, using a "telepheric" method. During the 4-month follow up, PET-scanner and chest X-ray demonstrated a significant reduction of the pleural effusion, and the patient reported complete clinical recovery. Central vein thrombosis is an unusual cause of chylothorax. We report a case of chylothorax complicating a brachiocephalic vein thrombosis successfully treated by percutaneous recanalization and stenting using a dual brachial and femoral approach. No thoracic duct embolization or ligature was required.
Identifiants
pubmed: 34889264
doi: 10.1097/MD.0000000000028100
pii: 00005792-202112100-00045
pmc: PMC8663897
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e28100Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflict of interest to disclose.
Références
Skouras V, Kalomenidis I. Chylothorax: diagnostic approach. Curr Opin Pulm Med 2010;16:387–93.
Hillerdal G. Chylothorax and pseudochylothorax. Eur Respir J 1997;10:1157–62.
McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 2010;104:01–8.
Elsevier, Doerr CH, Allen MS, Nichols Iii FC, et al. Etiology of Chylothorax in 203 Patients. 2005;867–870.
Rimensberger PC, Müller-Schenker B, Kalangos A, et al. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 1998;66:253–4.
Kho SS, Tie ST, Chan SK, et al. Chylothorax and central vein thrombosis, an under-recognized association: a case series. Respirol Case Rep 2017;5:e00221.
Thieme Medical Publishers, Chen E, Itkin M. Thoracic Duct Embolization for Chylous Leaks. 2011;063–074.
Chick JFB, Hage AN, Patel N, et al. Chylothorax secondary to venous outflow obstruction treated with transcervical retrograde thoracic duct cannulation with embolization and venous reconstruction. J Vasc Surg Cases Innovative Tech 2018;4:193–6.
Laslett D, Trerotola SO, Itkin M. Delayed complications following technically successful thoracic duct embolization. J Vasc Intervent Radiol 2012;23:76–9.