Talks
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Discipline/Specialty (Author 2)
Internal Medicine
Discipline/Specialty (Author 3)
Internal Medicine
Discipline Track
Patient Care
Abstract
Background: Chylothorax is the accumulation of the lymphatic fluid in the pleural space. Diagnosis of chylothorax is confirmed with pleural fluid analysis demonstrating triglycerides greater than 110 and cholesterol level less than 200mg/dl. Rarely, chylothorax can occur from damage to the thoracic duct from central venous cannulation
Case Presentation: A 48-year-old female with presented with gradual onset of shortness of breath for five days. She was noted to be hypoxic on arrival and was placed on non-rebreather oxygen therapy. Physical exam revealed decreased breathing sounds on the right side and was also noted for the right internal jugular dialysis catheter. Chest X-ray revealed bilateral pleural effusions, larger on the right. Lab work showed leukocytosis, WBC 20.7. CT lung confirmed the right pleural effusion. Thoracentesis removed 2 liters of pleural fluid which appeared milky pink in color. Pleural studies were negative for malignancy but revealed exudative effusion with pleural fluid triglycerides 1964, cholesterol of 112 diagnostics of chylothorax. She needed a repeat thoracentesis due to further re-accumulation in a few days.
Further review of the history revealed that the right internal jugular dialysis catheter was placed at an outside facility a few weeks ago. The dialysis catheter was removed. The patient was monitored following the catheter removal, however further accumulation of pleural effusion was minimal. The patient improved symptomatically and titrated off oxygen. She was referred for a lymphangiogram to another facility and outpatient follow-up.
Conclusion: Chylothorax in our patient was secondary to the recent placement of the right internal Juglar dialysis catheter. We managed our patients conservatively. There should be a high index of suspicion for chylothorax in the setting of the recently placed central line. Our case emphasizes considering chylothorax in the differential for pleural effusion in the setting of recent cannulation.
Presentation Type
Talk
Recommended Citation
Najam, Maria; Johal, Suneet; and Varghese, Nevin, "Case Report of Chylothorax from Venous Cannulation" (2023). Research Colloquium. 6.
https://scholarworks.utrgv.edu/colloquium/2022/talks/6
Ct scan demonstrated pleural effusion.jpg (387 kB)
milky apperance of fluid.docx (862 kB)
Included in
Case Report of Chylothorax from Venous Cannulation
Background: Chylothorax is the accumulation of the lymphatic fluid in the pleural space. Diagnosis of chylothorax is confirmed with pleural fluid analysis demonstrating triglycerides greater than 110 and cholesterol level less than 200mg/dl. Rarely, chylothorax can occur from damage to the thoracic duct from central venous cannulation
Case Presentation: A 48-year-old female with presented with gradual onset of shortness of breath for five days. She was noted to be hypoxic on arrival and was placed on non-rebreather oxygen therapy. Physical exam revealed decreased breathing sounds on the right side and was also noted for the right internal jugular dialysis catheter. Chest X-ray revealed bilateral pleural effusions, larger on the right. Lab work showed leukocytosis, WBC 20.7. CT lung confirmed the right pleural effusion. Thoracentesis removed 2 liters of pleural fluid which appeared milky pink in color. Pleural studies were negative for malignancy but revealed exudative effusion with pleural fluid triglycerides 1964, cholesterol of 112 diagnostics of chylothorax. She needed a repeat thoracentesis due to further re-accumulation in a few days.
Further review of the history revealed that the right internal jugular dialysis catheter was placed at an outside facility a few weeks ago. The dialysis catheter was removed. The patient was monitored following the catheter removal, however further accumulation of pleural effusion was minimal. The patient improved symptomatically and titrated off oxygen. She was referred for a lymphangiogram to another facility and outpatient follow-up.
Conclusion: Chylothorax in our patient was secondary to the recent placement of the right internal Juglar dialysis catheter. We managed our patients conservatively. There should be a high index of suspicion for chylothorax in the setting of the recently placed central line. Our case emphasizes considering chylothorax in the differential for pleural effusion in the setting of recent cannulation.