RT Journal Article
SR Electronic
T1 Bilateral chylothorax in a patient with chronic central vein thrombosis and chronic thromboembolic pulmonary hypertension (CTEPH)
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P594
VO 44
IS Suppl 58
A1 Avdhesh Bansal
A1 Trilok Chand Rao
A1 Kapil Sharma
A1 Rakesh Mahajan
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P594.abstract
AB Introduction Central venous thrombosis is not uncommon but is only rarely associated with chylothorax. Bilateral chylothorax associated with CTEPH and chronic DVT is even rarer.Case report A 44-year old female suffering from CTEPH and central vein DVT presented with two weeks history of increased breathlessness, bilateral chest discomfort and weakness. On examination, she was hypoxic and had signs of left pleural effusion. Chest X-ray and USG-chest showed gross left sided and mild right sided pleural effusion. Thoracocentesis was consistent with chylothorax. CT chest (contrast) showed multiple collateral formation of left side subclavian vein, venous doppler showed chronic DVT in right and left subclavian veins and echo showed finding of severe pulmonary hypertension. After 48 hours of fasting and conservative management, pleural drain became clear and decreased in amount. Patient underwent VATS and thoracic duct was ligated at diaphragmatic level and bilateral talc pleurodesis done. Patient improved clinically and radiologically.Discussion The possible cause of bilateral chylothorax in central vein thrombosis is due to rupture of thoracic duct and/or its collaterals as a result of increased pressure of the venous system exceeding the pressure in the thoracic duct (Blalock A, et al. Ann Surg 1936; 104:359–364) and also because accessory conduits function of accessory lymphatic channels is compromised by venous hypertension, which lead to elevated lymphatic pressures and pleural lymphatic engorgement (Kramer S, et al. Am J Roentgenol 1981; 137:559–563).Thoracic duct ligation and talc pleurodesis is the preferred mode of treatment in such patients.