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Woerde DJ, Palm CA, Duler LM, Cowgill LD, Ames MK, Culp WTN. Case report: Chylopericardium secondary to dialysis catheter related jugular venous thrombosis in two dogs receiving long-term hemodialysis. Front Vet Sci 2024; 11:1386710. [PMID: 38831956 PMCID: PMC11144879 DOI: 10.3389/fvets.2024.1386710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Chylopericardium is a rare entity in veterinary medicine. In this report we document the development of chylopericardium in two dogs undergoing chronic hemodialysis. An 11-year-old female spayed Labrador retriever (Case 1) presented with acute coughing and lethargy 2 months following initial dialysis catheter placement and initiation of dialysis therapy for severe azotemia. Echocardiography demonstrated severe pericardial effusion and cardiac tamponade. Pericardial fluid analysis was consistent with chylous effusion. The dog underwent a subtotal pericardiectomy with thoracic duct ligation, and a PleuralPort™ was placed. The patient continued to receive outpatient hemodialysis therapy after pericardiectomy for several months until she died acutely at home. A 4-year-old male neutered Doberman (Case 2) was being treated for 2 months with outpatient hemodialysis for management of chronic kidney disease. On presentation for the 17th hemodialysis treatment, the patient had increased respiratory rate. Echocardiography demonstrated pleural and pericardial effusions, and fluid analysis in both cavities was consistent with chylous effusion. Use of tissue plasminogen activator (TPA), clot removal and replacement of the catheter was attempted; however pleural and pericardial effusion continued. The patient was euthanized after 25 hemodialysis sessions as owners elected not to pursue more procedures. In both cases, the cause of the chylopericardium was suspected to be secondary to catheter-associated thrombosis and/or stenosis based on multiple imaging modalities. Despite use of rivaroxaban and clopidogrel concurrently in each case, the chylous effusion persisted. This case report describes clinical details of a rare complication of long-term indwelling dialysis catheters in two dogs.
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Affiliation(s)
- Dennis J. Woerde
- William R Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States
| | - Carrie A. Palm
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, Davis, CA, United States
| | - Laetitia M. Duler
- William R Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, Davis, CA, United States
| | - Larry D. Cowgill
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, Davis, CA, United States
| | - Marisa K. Ames
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, Davis, CA, United States
| | - William T. N. Culp
- Department of Surgical & Radiological Sciences, University of California, Davis, Davis, CA, United States
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Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
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Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
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3
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Cook S, Ali S, Pracher F, Gautam A. Chylothorax complicating central venous access and thoracocentesis in an infant with parapneumonic empyema. J Paediatr Child Health 2021; 57:1331-1333. [PMID: 32987446 DOI: 10.1111/jpc.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/16/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel Cook
- Townsville Hospital, Douglas, Queensland, Australia
| | - Sara Ali
- Townsville Hospital, Douglas, Queensland, Australia
| | | | - Anil Gautam
- Townsville Hospital, Douglas, Queensland, Australia
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4
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Milandt N, Birkelund T, Engholm M. Acute Chylopericardium With Tamponade and Cardiac Arrest With Pseudomyxoma Peritonei. Am J Cardiol 2021; 146:134-136. [PMID: 33548186 DOI: 10.1016/j.amjcard.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022]
Abstract
A 51-year-old woman with pseudomyxoma peritonei developed cardiac arrest 5 days after surgery. Acute echocardiography demonstrated pericardial tamponade. Emergency pericardiocentesis evacuated milky fluid and circulation was re-established. Analysis of the pericardial fluid suggested chylopericardium. In conclusion, this case demonstrates that chylopericardium may be life-threatening and underlines the importance of acute echocardiography in critical management of patients with unexplained shock.
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Affiliation(s)
- Nikolaj Milandt
- Department of Intensive Care Medicine, Aarhus University Hospital, Denmark.
| | - Thomas Birkelund
- Department of Intensive Care Medicine, Aarhus University Hospital, Denmark
| | - Morten Engholm
- Department of Cardiology, Aarhus University Hospital, Denmark
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5
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Jones KA, Sadri S, Ahmad N, Weintraub JR, Reis SP. Thoracic Trauma, Nonaortic Injuries. Semin Intervent Radiol 2021; 38:75-83. [PMID: 33883804 DOI: 10.1055/s-0041-1726005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Trauma is one of the leading causes of death worldwide. Approximately two-thirds of trauma patients have thoracic injuries. Nonvascular injury to the chest is most common; however, while vascular injuries to the chest make up a small minority of injuries in thoracic trauma, these injuries are most likely to require intervention by interventional radiology (IR). IR plays a vital role, with much to offer, in the evaluation and management of patients with both vascular and nonvascular thoracic trauma; in many cases, IR treatments obviate the need for these patients to go to the operating room. This article reviews the role of IR in the treatment of vascular an nonvascular traumatic thoracic injuries.
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Affiliation(s)
- Kai A Jones
- Columbia University Vegelos College of Physicians and Surgeons, New York, New York
| | - Shirin Sadri
- Columbia University Vegelos College of Physicians and Surgeons, New York, New York
| | - Noor Ahmad
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York
| | | | - Stephen P Reis
- Division of Interventional Radiology, Columbia University Irving Medical Center, New York, New York
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6
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Makarova MA, Baimakanova GE, Krasovsky SA. Differential diagnosis of chylothorax in therapeutic practice. TERAPEVT ARKH 2021; 93:320-326. [DOI: 10.26442/00403660.2021.03.200658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
The article is devoted to the differential diagnosis of chylous pleural effusion. The spectrum of traumatic and non-traumatic causes of chylothorax is discussed in detail. Examples of necessary diagnostic measures are given for the accumulation of milky fluid in the pleural cavity in order to verify chylothorax.
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Dasatinib-induced Chylothorax in Chronic Myelogenous Leukemia in Pediatric Patient: Report of a Case and Review of Literature. J Pediatr Hematol Oncol 2020; 42:e665-e667. [PMID: 31688632 DOI: 10.1097/mph.0000000000001619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dasatinib is a second-generation potent and efficacious oral tyrosine kinase inhibitor frequently used for imatinib-resistant or intolerant BCR-ABL-positive chronic myeloid leukemia and for Philadelphia chromosome-positive acute lymphocytic leukemia. Dasatinib is known to cause adverse pulmonary events such as chylothorax and has been described in the adult literature but not pediatric literature. The authors present a pediatric case of dasatinib-related chylothorax, subsequent management, and a review of the literature of adult cases with dasatinib-related chylothorax.
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Germ Cell Tumour of the Ovary Presenting with Chylothorax and Central Vein Thrombosis: a Case Report. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-0377-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gohar A, Jamous F, Meyer N. Chylothorax as a complication of extensive spontaneous left arm DVT. BMJ Case Rep 2019; 12:12/12/e232563. [PMID: 31892625 DOI: 10.1136/bcr-2019-232563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We present a case of right sided chylothorax in the setting of cirrhosis believed to be secondary to extensive venous thromboembolism of the left upper extremity and exacerbated by chylous ascites. Our patient responded to conservative management with anticoagulation and a repeat thoracentesis revealed transformation of the fluid back to straw coloured transudate. We also include a brief discussion of the diagnosis and management of chylothorax.
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Affiliation(s)
- Ahmed Gohar
- Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
| | - Fady Jamous
- Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA.,Pulmonary & Sleep Medicine, Avera Medical Group, Sioux Falls, South Dakota, USA
| | - Natasha Meyer
- Pulmonary & Sleep Medicine, Avera Medical Group, Sioux Falls, South Dakota, USA
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Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S. Chylothorax after hepatectomy: a case report. J Med Case Rep 2018; 12:347. [PMID: 30474568 PMCID: PMC6260677 DOI: 10.1186/s13256-018-1882-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/15/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Chylothorax is the accumulation of chyle within the pleural space. Chylothorax can occur as a complication after multiple different types of surgery, most frequently after thoracic surgery, albeit with an incidence rate of less than 1%. Chylothorax after abdominal surgery is extremely rare, and there are only a few case reports. CASE PRESENTATION A 74-year-old Japanese woman presented with jaundice. She was diagnosed as having hilar cholangiocarcinoma and underwent right hepatectomy, caudate lobectomy, extrahepatic bile duct resection, and lymph node dissection after preoperative percutaneous transhepatic portal vein embolization. Postoperative liver function was normal. She developed chylous ascites on postoperative day 5, for which conservative treatment was initially effective. Dyspnea developed suddenly on postoperative day 42, and she had a massive right pleural effusion and a small amount of ascites. Management with pleural drainage, total parenteral nutrition, and octreotide injections decreased the chylothorax. However, the chylous effusion reaccumulated on postoperative day 57. As conservative treatments ultimately failed, lymphangiography was performed on postoperative day 62. Lymphangiography with Lipiodol (ethiodized oil) revealed extravasation into the pleural space, but the location of the leak was not identified. There was neither obstruction nor dilation of the thoracic duct. A lymphatic leak in her abdominal cavity was not demonstrated. A chest tube was placed after lymphangiography, and the chylothorax was diminished by postoperative day 71. She was discharged on postoperative day 72. Two and a half years after surgery, she is doing well with no evidence of recurrence of either chylothorax or cancer. CONCLUSIONS Chylothorax can occur after hepatectomy and pleural effusion should raise suspicion for chylothorax. Lymphangiography may be effective for both diagnosis and treatment in the case of chylothorax after hepatectomy.
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Affiliation(s)
- Ryusei Yamamoto
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hideo Matsubara
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hirokazu Kaneko
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Shinsuke Iyomasa
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
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11
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Kho SS, Tie ST, Chan SK, Yong MC, Chai SL, Voon PJ. Chylothorax and central vein thrombosis, an under-recognized association: a case series. Respirol Case Rep 2017; 5:e00221. [PMID: 28250931 PMCID: PMC5325873 DOI: 10.1002/rcr2.221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/14/2017] [Accepted: 01/24/2017] [Indexed: 01/31/2023] Open
Abstract
Chylothorax is defined as the presence of chyle in the pleural cavity. Central vein thrombosis is an under‐recognized cause of chylothorax in the adult population and is commonly related to central venous catheterization. Case 1 illustrates a patient with AIDS and disseminated tuberculosis with left chylothorax and central vein thrombosis after a month of antituberculosis therapy. Case 2 was a patient with advanced seminoma who presented with left chylothorax and central vein thrombosis while on chemotherapy. Chylothorax resolved with anticoagulation for both cases. Case 3 was a lymphoma patient with central vein thrombosis who developed chylothorax during chemotherapy. Chylothorax resolved with the continuation of anticoagulation and did not recur despite his progressive underlying lymphoma. There was no central venous catheterization in any of these three cases. These cases illustrate the unique association of central vein thrombosis and chylothorax and the importance of anticoagulation in its management.
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Affiliation(s)
- Sze Shyang Kho
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Siew Teck Tie
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Swee Kim Chan
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Mei Ching Yong
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Sing Ling Chai
- Department of Diagnostic Imaging Sarawak General Hospital Kuching Malaysia
| | - Pei Jye Voon
- Department of Radiotherapy and Oncology Unit Sarawak General Hospital Kuching Malaysia
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12
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Baloch ZQ, Abbas SA, Bhatti H, Braver Y, Ali SK. Dasatinib-induced chylothorax in chronic myeloid leukemia. Proc AMIA Symp 2017; 30:71-73. [PMID: 28127140 PMCID: PMC5242121 DOI: 10.1080/08998280.2017.11929535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Pulmonary adverse events are common abnormalities associated with the use of dasatinib in chronic myeloid leukemia. We present a case of a 69-year-old man who suddenly developed a rare chylothorax pulmonary adverse event following 10 months of dasatinib treatment.
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Affiliation(s)
- Zulfiqar Qutrio Baloch
- Department of Internal Medicine, Brandon Regional Hospital, Brandon, Florida (Baloch, Braver); R-Research, Hamilton, New Jersey (Abbas); and Departments of Pulmonary Critical Care (Bhatti) and Internal Medicine/Palliative Care (Ali), Orlando Veterans Affairs Medical Center, Orlando, Florida
| | - Shabber Agha Abbas
- Department of Internal Medicine, Brandon Regional Hospital, Brandon, Florida (Baloch, Braver); R-Research, Hamilton, New Jersey (Abbas); and Departments of Pulmonary Critical Care (Bhatti) and Internal Medicine/Palliative Care (Ali), Orlando Veterans Affairs Medical Center, Orlando, Florida
| | - Hammad Bhatti
- Department of Internal Medicine, Brandon Regional Hospital, Brandon, Florida (Baloch, Braver); R-Research, Hamilton, New Jersey (Abbas); and Departments of Pulmonary Critical Care (Bhatti) and Internal Medicine/Palliative Care (Ali), Orlando Veterans Affairs Medical Center, Orlando, Florida
| | - Yvonne Braver
- Department of Internal Medicine, Brandon Regional Hospital, Brandon, Florida (Baloch, Braver); R-Research, Hamilton, New Jersey (Abbas); and Departments of Pulmonary Critical Care (Bhatti) and Internal Medicine/Palliative Care (Ali), Orlando Veterans Affairs Medical Center, Orlando, Florida
| | - Sayed K Ali
- Department of Internal Medicine, Brandon Regional Hospital, Brandon, Florida (Baloch, Braver); R-Research, Hamilton, New Jersey (Abbas); and Departments of Pulmonary Critical Care (Bhatti) and Internal Medicine/Palliative Care (Ali), Orlando Veterans Affairs Medical Center, Orlando, Florida
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Kaji T, Kawano T, Yamada W, Yamada K, Onishi S, Nakame K, Mukai M, Ieiri S, Takamatsu H. The changing profile of safe techniques for the insertion of a central venous catheter in pediatric patients - improvement in the outcome with the experiences of 500 insertions in a single institution. J Pediatr Surg 2016; 51:2044-2047. [PMID: 27829522 DOI: 10.1016/j.jpedsurg.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/12/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The ability to safely insert a central venous catheter (CVC) is critical to avoid associated complications. The aim of this study was to explore appropriate technique to maintain the safety of pediatric patients during CVC. METHODS We reviewed the surgical records of CVC insertion techniques and associated complications of 503 tunneled CVC insertions performed from 2000 to 2015. RESULTS Two hundred thirty CVCs (45.7%) were inserted into the subclavian vein using the landmark technique for 10years (first period). Only two pneumothoraxes (0.9%) were experienced. In 2009, we adopted ultrasound-guided venous catheterization from the internal jugular vein, and 103 CVCs (20.5%) were inserted (second period). This procedure led to penetration into the innominate vein (1.0%) by dilater sheath. Patient underwent repair of the penetrated vessel. After this serious complication, 170 CVCs (33.8%) were inserted using the venous cutdown procedure except two catheters. We had two cases whose accessible veins were occluded because of frequent catheterization using venous cutdown technique. No mechanical complications were experienced. CONCLUSIONS The venous cutdown method is the safest technique for inserting a tunneled CVC in pediatric patients. However, multiple vein occlusions because of repeated catheterizaion by venous cutdown lead to the exhaustion of accessible vessels. LEVEL OF EVIDENCE Treatment Study - Level IV.
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Affiliation(s)
- Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University.
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Johnson OW, Chick JFB, Chauhan NR, Fairchild AH, Fan CM, Stecker MS, Killoran TP, Suzuki-Han A. The thoracic duct: clinical importance, anatomic variation, imaging, and embolization. Eur Radiol 2015; 26:2482-93. [PMID: 26628065 DOI: 10.1007/s00330-015-4112-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/31/2015] [Accepted: 11/11/2015] [Indexed: 01/30/2023]
Abstract
UNLABELLED The thoracic duct is the body's largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the thoracic duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes. Disruption of the thoracic duct frequently results in chylothoraces, which subsequently cause an immunocompromised state, contribute to nutritional depletion, and impair respiratory function. Although conservative dietary treatments exist, the majority of thoracic duct disruptions require embolization in the interventional suite. This article provides a comprehensive review of the clinical importance of the thoracic duct, relevant anatomic variants, imaging, and embolization techniques for both diagnostic and interventional radiologists as well as for the general medical practitioner. KEY POINTS • Describe clinical importance, embryologic origin, and typical course of the thoracic duct. • Depict common/lesser-known thoracic duct anatomic variants and discuss their clinical significance. • Outline the common causes of thoracic duct injury and indications for embolization. • Review the thoracic duct embolization procedure including both pedal and intranodal approaches. • Present and illustrate the success rates and complications associated with the procedure.
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Affiliation(s)
- Oren W Johnson
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Nikunj Rashmikant Chauhan
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Alexandra Holmsen Fairchild
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Chieh-Min Fan
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael S Stecker
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Timothy P Killoran
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Alisa Suzuki-Han
- Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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15
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Ismail SR, Elbarbary M, Kabbani MS. Successful use of recombinant tissue plasminogen activator (r-TPA) for management of chylothorax associated with central venous thrombosis after neonatal cardiac surgery. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Law MA, McMahon WS, Hock KM, Zaccagni HJ, Borasino S, Alten JA. Balloon Angioplasty for the Treatment of Left Innominate Vein Obstruction Related Chylothorax after Congenital Heart Surgery. CONGENIT HEART DIS 2015; 10:E155-63. [PMID: 25600286 DOI: 10.1111/chd.12246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chylothorax complicates the postoperative course of patients after congenital heart surgery. Innominate vein thrombosis and stenosis have been associated with postoperative chylothorax. Revascularization and angioplasty can be accomplished using transcatheter techniques. We report our experience with this procedure for the management of postoperative chylothorax. DESIGN This is a retrospective case series of patients who underwent catheter revascularization and/or angioplasty of the innominate vein following cardiac surgery at our institution from January 1, 2008 through April 9, 2014. SETTING The cardiovascular intensive care unit and cardiac catheterization laboratory at the University of Alabama at Birmingham and Benjamin Russell Hospital for Children in Birmingham, Alabama were used as settings for the study. PATIENTS Out of 112 patients with postoperative chylothorax, 7 (6.3%) underwent transcatheter dilation of the innominate vein for occlusion/stenosis. The median age of the cohort was 1 month (15 days-6 years); median weight was 3 kg (2.7-22.2). Diagnosis was made a median 8 days (2-20) and persisted for a median of 24 days (9-44). Most patients failed medical management (low fat diet, nothing by mouth, and/or octreotide). RESULTS Cardiac catheterization occurred at a median 9 days (2-29) after chylothorax diagnosis. Median chest tube output on the day prior to procedure was 63 (12-149) cc/kg/day and decreased to 23 (0-64) cc/kg/day 2 days postprocedure (P = .01). Effusions resolved in a median of 5 days (1-16). There were no clinical complications postcatheterization. All patients who have undergone repeat angiography have maintained patency of the innominate vein. There was no mortality. Complications from chylothorax included prolong hospitalization, hyponatremia, hypoproteinemia, coagulopathy, lymphopenia, and infection. CONCLUSIONS Innominate vein occlusion and stenosis associated with chylous effusion are amenable to transcatheter revascularization and/or angioplasty, consistently leading to improvement, if not full resolution of chylothorax.
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Affiliation(s)
- Mark A Law
- Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - William S McMahon
- Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Kristal M Hock
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Hayden J Zaccagni
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Santiago Borasino
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
| | - Jeffrey A Alten
- Department of Pediatric Cardiac Critical Care, University of Alabama at Birmingham, Birmingham, Ala, USA
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17
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Rajpal MN, Buechler LS, Rao R. Chylous cardiac tamponade due to catheter-associated thrombosis of intrathoracic veins in a newborn infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Siu SLY, Yang JYK, Hui JPK, Li RCH, Cheng VYW, Cheung TWY, Kwong ANS. Chylothorax secondary to catheter related thrombosis successfully treated with heparin. J Paediatr Child Health 2012; 48:E105-7. [PMID: 21244542 DOI: 10.1111/j.1440-1754.2010.01936.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It has been well recognized that intra-thoracic surgery is a major cause of chylothorax in the newborn period; however, catheter-related thrombosis could also be a cause. We report a preterm baby who presented with right chylothorax secondary to venous thrombosis postinadvertent right internal jugular vein catheterization. The complication resolved with drainage, catheter removal and low molecular weight heparin. The literature on neonatal chylothorax and thrombosis and case reports reporting thrombosis-related chylothorax that have been successfully treated with anticoagulation are reviewed.
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Affiliation(s)
- Sylvia L Y Siu
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, N.T. Hong Kong, China.
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19
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Bhole V, Gozzini S, Stumper O, Advani S, Sullivan PB, Rodrigues AF, Gupte GL. Chylopericardium in a child with impaired venous access following small bowel transplantation. Pediatr Transplant 2011; 15:e39-41. [PMID: 19843235 DOI: 10.1111/j.1399-3046.2009.01250.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 10-yr-old child with impaired venous access (bilateral occlusion of internal jugular veins, subclavian veins, and inominate veins) underwent an isolated small bowel transplant. He presented with lethargy, shortness of breath 13 months into his follow-up and was diagnosed to have chylopericardium. MR venography and lymphangiography could not demonstrate the site of lymphatic leak. His chyloperciardium was treated with pericardiocentesis and MCT diet. The most likely cause for the chylopericardium was venous occlusion of the subclavian veins with backpressure resulting in a lymphatic leak. A brief review of literature along with treatment options is discussed.
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Affiliation(s)
- V Bhole
- Cardiology Unit, Birmingham Children's Hospital, Birmingham, UK
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20
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McGrath EE, Blades Z, Anderson PB. Chylothorax: Aetiology, diagnosis and therapeutic options. Respir Med 2010; 104:1-8. [PMID: 19766473 DOI: 10.1016/j.rmed.2009.08.010] [Citation(s) in RCA: 248] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 07/22/2009] [Accepted: 08/07/2009] [Indexed: 01/30/2023]
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21
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Diamond JM, Kotloff RM, Liu CF, Cooper JM. Severe venous and lymphatic obstruction after single-chamber pacemaker implantation in a patient with chest radiation therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 33:520-4. [PMID: 20025702 DOI: 10.1111/j.1540-8159.2009.02652.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 73-year-old woman with a history of paroxysmal atrial fibrillation, sinus node dysfunction, bilateral breast cancer, and extensive chest radiation developed progressive edema, dyspnea, and recurrent pleural effusions soon after single-chamber pacemaker implantation. Thoracentesis yielded a diagnosis of chylothorax, and progressive refractory anasarca developed. A computed tomography angiogram suggested obstruction of the superior vena cava and left subclavian vein despite outpatient therapeutic anticoagulation. Autopsy confirmed venous thrombosis, along with mediastinal fibrosis. The presumed etiology of the chylothorax and anasarca was obstruction of the atretic central venous structures following pacemaker implantation, critically impairing the already tenuous venous and lymphatic drainage. (PACE 2010; 520-524).
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Affiliation(s)
- Joshua M Diamond
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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22
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Adekile A, Adegoroye A, Tedla F, Levin D, Salifu MO. Chylothorax and chylopericardial tamponade in a hemodialysis patient with catheter-induced superior vena cava stenosis. Semin Dial 2009; 22:576-9. [PMID: 19747178 DOI: 10.1111/j.1525-139x.2009.00622.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Chylothorax and chylopericardium refer to the presence of milky, triglyceride-rich chylous fluid in the thoracic and pericardial spaces, respectively. Both conditions are extremely uncommon in end-stage renal disease patients on dialysis. We report the first known case of combined chylothorax and chylous pericardial tamponade in a dialysis patient associated with catheter-induced superior vena cava (SVC) stenosis. A successful outcome was achieved with drainage of both chylous effusions in combination with angioplasty of the SVC stenosis.
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Affiliation(s)
- Ayoola Adekile
- Divisions of Nephrology, State University of New York, Downstate Medical Center, Brooklyn, New York 11203, USA
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23
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Postoperative chylothorax development is associated with increased incidence and risk profile for central venous thromboses. Pediatr Cardiol 2008; 29:556-61. [PMID: 18030412 DOI: 10.1007/s00246-007-9140-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 09/19/2007] [Accepted: 10/21/2007] [Indexed: 10/22/2022]
Abstract
This study tested the hypothesis that pediatric patients who develop chylothorax (CTX) after surgery for congenital heart disease (CHD) have an elevated incidence and risk profile for central venous thrombosis (CVT). We evaluated 30 patients who developed CTX after surgery for CHD. All but one CTX patient were surgery-, anatomy-, and age-matched with two controls (NON-CTX) to compare their relative risk and incidence of CVT. Using conditional logistic regression analyses, CTX development was associated with significantly longer ventilator dependence (14.8 +/- 10.9 vs. 6.1 +/- 5.9 days, p = 0.003) and a non-significant trend towards more days of central venous catheters (CVC) (19.1 +/- 16.6 vs. 12.2 +/- 10.0 days; p = 0.16) when comparing the period prior to CTX development with the entire hospitalization in NON-CTX patients. CTX development was associated with a significantly elevated mortality risk (Odds Ratio 6.2, 95% CI 1.3-30.9). Minimum and mean daily central venous pressures were significantly higher in the CTX group. Post operative need for extracorporeal membrane oxygenation conferred an increased risk of CTX development in this sample of patients (Odds Ratio 9.9, 95% CI 2.2-44.8). Incidence of documented CVT was 26.7% in the CTX group versus 5.1% in the NON-CTX group. Prospective screening for CVT risk and formation, combined with early removal of CVC may help reduce the incidence of CTX.
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24
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Velinović M, Vranes M, Kocica M, Djukić P, Mikić A, Vukomanović V, Kacar S, Putnik S, Marković D, Seferović PM. [Chylopericardium as a complication of cardiac surgery: report of two cases and review of the literature]. SRP ARK CELOK LEK 2007; 135:88-91. [PMID: 17503575 DOI: 10.2298/sarh0702088v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Chylopericardium refers to existing communication between the pericardial sac and the thoracic duct carrying the chyle. The objective of our report was to highlight the specificity of diagnosis and treatment of this rare but tedious condition through the analysis of two case reports. Male patient, aged 63 years, with chylopericardium was diagnosed perioperatively (implantation of artificial aortic--St. Jude No 21 and mitral valve--St. Jude No 29). Etiology of pericardial effusion was established by Sudan III staining of punctate specimen obtained by subxiphoid pericardial puncture. Probable cause of chylopericardium was the lesion of ductus thoracicus during cross-clamping of the superior caval vein with a Cooley clamp. Initial treatment included diet rich in medium-chain triglycerides which resulted in resolution of the effusion. During five-year follow-up, there were no recurrences of pericardial effusion. The second patient was female, 21 years old, with chylopericardium after partial pericardiectomy performed because of the chronic severely symptomatic pericardial effusion, resistant to other forms of treatment. Pericardiocentesis provided 650 ml of yellowish fluid with a high concentration of cholesterol (3.2 mmol/l), triglycerides (16.6 mmol/l), and proteins (64.7 g/l), which verified chylopericardium, most probably as a consequence of the lesion of ductus thoracicus during partial pericardiectomy. Diet rich in medium-chain triglycerides failed to decrease the effusion, after two weeks of treatment (daily secretion 250-350 ml). Lymphography revealed lesion of ductus thoracicus, most probably at Th9/Th10 level, with no direct visualization of extravasal accumulation of contrast media. Surgical ligation of ductus thoracicus was performed through the right thoracotomy. However, postoperative secretion increased to 1000 ml/day. Patient underwent redo surgery comprising the ligation of lymphatic vessels, guided by extravasation of intraoperatively iwected methylene-blue indicator. During one-year follow-up, there were no recurrences of pericardial effusion. In conclusion, intraoperative lymphography significantly contributed to successful surgical treatment of patients with chylopericardium.
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25
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Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 2007; 32:362-9. [PMID: 17580118 DOI: 10.1016/j.ejcts.2007.04.024] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 04/15/2007] [Accepted: 04/18/2007] [Indexed: 12/16/2022] Open
Abstract
Though rare in incidence, chylothorax can lead to significant morbidity and mortality. Its occurrence corresponds to increased mortality following esophagectomy. Leakage of chyle and lymph leads to significant loss of essential proteins, immunoglobulins, fat, vitamins, electrolytes and water. The presence of chylomicrons and a triglyceride level >110 mg/dl in the aspirated pleural fluid confirms the diagnosis of chylothorax. Identifying the aetiology using different diagnostic tests is important in planning treatment. While therapeutic thoracentesis provides relief from respiratory symptoms, the nutritional deficiency will continue to persist or deteriorate unless definitive therapeutic measures are instituted to stop leakage of chyle into the pleural space. Definitive therapy consists of obliteration and prevention of recurrence of chylothorax. Aggressive surgical therapy is recommended for post-traumatic or post-surgical chylothorax.
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Affiliation(s)
- Sukumaran K Nair
- Department of Cardiothoracic Surgery, The Heart Hospital, University College London NHS Trust, 16-18 Westmoreland Street, London W1G 8PH, United Kingdom.
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26
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Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg 2007; 204:681-96. [PMID: 17382229 DOI: 10.1016/j.jamcollsurg.2007.01.039] [Citation(s) in RCA: 227] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 01/16/2007] [Accepted: 01/17/2007] [Indexed: 12/13/2022]
Affiliation(s)
- Roberto E Kusminsky
- Department of Surgery, West Virginia University, Robert C Byrd Health Sciences Center, Charleston Division and Charleston Area Medical Center, Charleston, WV 25304, USA
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27
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Beljaars GH, Van Schil P, De Weerdt A, Suys B, Wojciechowski M, Jorens PG. Chylothorax, an unusual mechanical complication after central venous cannulation in children. Eur J Pediatr 2006; 165:646-7. [PMID: 16636813 DOI: 10.1007/s00431-006-0145-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 03/21/2006] [Indexed: 11/30/2022]
Affiliation(s)
- Guus H Beljaars
- Department of Paediatric Intensive Care Medicine, University Hospital of Antwerp, Wilrijkstraat 10, 2050 Edegem, Belgium
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28
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Lee N, Coco M. Chylous pericardial tamponade in a haemodialysis patient with catheter-associated thrombosis of internal jugular and subclavian veins. Nephrol Dial Transplant 2006; 21:2650-3. [PMID: 16627608 DOI: 10.1093/ndt/gfl166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Najin Lee
- Department of Medicine, Renal Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY10467, USA
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30
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Abstract
This article about antithrombotic therapy in children is part of the 7th American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh the risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this article are the following. In neonates with venous thromboembolism (VTE), we suggest treatment with either unfractionated heparin or low-molecular-weight heparin (LMWH), or radiographic monitoring and anticoagulation therapy if extension occurs (Grade 2C). We suggest that clinicians not use thrombolytic therapy for treating VTE in neonates, unless there is major vessel occlusion that is causing the critical compromise of organs or limbs (Grade 2C). For children (ie, > 2 months of age) with an initial VTE, we recommend treatment with i.v. heparin or LMWH (Grade 1C+). We suggest continuing anticoagulant therapy for idiopathic thromboembolic events (TEs) for at least 6 months using vitamin K antagonists (target international normalized ratio [INR], 2.5; INR range, 2.0 to 3.0) or alternatively LMWH (Grade 2C). We suggest that clinicians not use thrombolytic therapy routinely for VTE in children (Grade 2C). For neonates and children requiring cardiac catheterization (CC) via an artery, we recommend i.v. heparin prophylaxis (Grade 1A). We suggest the use of heparin doses of 100 to 150 U/kg as a bolus and that further doses may be required in prolonged procedures (both Grade 2 B). For prophylaxis for CC, we recommend against aspirin therapy (Grade 1B). For neonates and children with peripheral arterial catheters in situ, we recommend the administration of low-dose heparin through a catheter, preferably by continuous infusion to prolong the catheter patency (Grade 1A). For children with a peripheral arterial catheter-related TE, we suggest the immediate removal of the catheter (Grade 2C). For prevention of aortic thrombosis secondary to the use of umbilical artery catheters in neonates, we suggest low-dose heparin infusion (1 to 5 U/h) (Grade 2A). In children with Kawasaki disease, we recommend therapy with aspirin in high doses initially (80 to 100 mg/kg/d during the acute phase, for up to 14 days) and then in lower doses (3 to 5 mg/kg/d for > or = 7 weeks) [Grade 1C+], as well as therapy with i.v. gammaglobulin within 10 days of the onset of symptoms (Grade 1A).
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Affiliation(s)
- Paul Monagle
- Division of Laboratory Services, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Flemington Rd, Parkville, Melbourne, VIC, Australia 3052.
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31
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Abstract
Thromboembolic disease (TE) has been described as the new epidemic of tertiary paediatrics, and no where is this more evident than in the neonatal population. As survival of premature and sick newborns has improved, the frequency of complications associated with intensive supportive therapy and monitoring has increased. Clinically significant thrombosis is emerging as one of the more common complications associated with improved neonatal outcome. The long-term implications of neonatal thrombosis are only just being realised. This systematic review will consider the epidemiology, diagnostic strategies, and outcome for both arterial and venous TE in neonates. The role of inherited thrombophilic abnormalities, and the evidence for anticoagulation therapy will also be considered. The lack of high level evidence in determining optimum therapy is obvious. Further research regarding diagnostic strategies, and optimal therapies is urgently needed.
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Affiliation(s)
- A Greenway
- Division of Laboratory Services, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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Tomić I, Plavec G, Karlicić V, Spasić V, Rusović S, Stanić V, Cvijanović V, Ristanović A. [Chylous effusions]. VOJNOSANIT PREGL 2003; 60:613-20. [PMID: 14608841 DOI: 10.2298/vsp0305613t] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This paper presents 4 patients with chylothorax, and one patient with bilateral chylothorax and chyloperitoneum. The chylous effusions were of benign etiology, developed as a complication of miliary tuberculosis (1 patient), after L-2 vertebral body fracture (1 patient), and idiopathic (2 patients). The diagnosis was confirmed by the presence of chylomicrons and high content of triglycerides in the effusion, ranged 11.9-29.1 mmol/l. Lymphangiography showed multiple abnormalities of lymphatic system, the obstruction of ductus thoracicus, dilatation and convulsion of lymphatic channels, but the site of lymphatic leak was not detected. The treatment included an extended period of pleural and peritoneal drainage with total parenteral nutrition (1 patient), pleurodesis using Corynebacterium parvum (2 patients), and surgical partial parietal pleurectomy with continuous drainage (1 patient). The treatment was successful in all patients.
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Affiliation(s)
- Ilija Tomić
- Vojnomedicinska akademija, Klinika za plućne bolesti, Beograd
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33
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Abstract
Use of central venous catheters has become standard in the treatment of many chronic conditions during childhood and for the acute treatment of critically ill infants and children. However, these catheters can be associated with numerous complications, including thrombosis at the tip or in the lumen causing difficulty with its overall function. Even more concerning is the occlusion of large veins into which the catheter is placed, which could predispose patients to pulmonary embolism or postthrombotic syndrome. Recent research has focused on identifying risk factors for catheter-related thrombosis in children and determining methods for diagnosing deep venous thrombosis associated with a catheter in the upper extremities. Evidence now exists that as many as 50% of children with catheters develop deep venous thrombosis; however, most events are clinically silent. Few clinical trials have studied prevention of catheter-related thrombosis in pediatric patients. Data regarding incidence, treatment, and long-term outcome of catheter-related thrombosis in children are limited. Although central venous catheters are extremely important in the supportive care of sick children, concerns remain about their immediate and long-term safety.
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Affiliation(s)
- Janna M Journeycake
- Department of Pediatrics, Division of Hematology/Oncology, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA.
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34
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Mallick A, Bodenham AR. Disorders of the lymph circulation: their relevance to anaesthesia and intensive care. Br J Anaesth 2003; 91:265-72. [PMID: 12878626 DOI: 10.1093/bja/aeg155] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The lymphatic system is known to perform three major functions in the body: drainage of excess interstitial fluid and proteins back to the systemic circulation; regulation of immune responses by both cellular and humoral mechanisms; and absorption of lipids from the intestine. Lymphatic disorders are seen following malignancy, congenital malformations, thoracic and abdominal surgery, trauma, and infectious diseases. They can occasionally cause mortality, and frequently morbidity and cosmetic disfiguration. Many lymphatic disorders are encountered in the operating theatre and critical care settings. Disorders of the lymphatic circulation relevant to anaesthesia and intensive care medicine are discussed in this review.
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Affiliation(s)
- A Mallick
- Department of Anaesthesia, Leeds General Infirmary, United Leeds Teaching Hospitals, Leeds LS1 3EX, UK
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35
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Berkenbosch JW, Monteleone PM, Tobias JD. Chylothorax following apparently spontaneous central venous thrombosis in a patient with septic shock. Pediatr Pulmonol 2003; 35:230-3. [PMID: 12567393 DOI: 10.1002/ppul.10246] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Within the pediatric age group, chylothorax is rare and has been reported almost exclusively in the setting of thoracic surgical procedures or central venous hypertension secondary to central venous catheter thrombosis. We report on the development of central venous thrombosis and chylothorax in the absence of the usual risk factors in a patient with septic shock, and we expand on the role that procoagulant states, such as those induced by sepsis, might play in the development of this complication. This case reminds the practitioner that central venous thromboses and their complications may occur in the absence of the usually reported risk factors and must therefore still be considered when other clinical events suggest their presence.
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Affiliation(s)
- John W Berkenbosch
- Department of Child Health, University of Missouri, Columbia, Missouri 65212, USA.
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36
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Pettit J. Assessment of infants with peripherally inserted central catheters: Part 2. Detecting less frequently occurring complications. Adv Neonatal Care 2003; 3:14-26. [PMID: 12882178 DOI: 10.1053/adnc.2003.50011] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripherally inserted central catheters (PICCs) are frequently placed in neonates to optimize nutrition and provide stable infusions of critical medications into the central vascular system. PICCs have been associated with a number of device-specific complications that can manifest during insertion, while the line is indwelling, and/or after the removal of the line. The first article of this series in Focus on the Physical, titled "Assessment of Infants With Peripherally Inserted Central Catheters: Part I. Detecting the Most Frequently Occurring Complications," presented assessment strategies to detect common complications such as catheter occlusions and catheter-related bloodstream infections. Part 2 of this series emphasizes the importance of ongoing systematic assessment of PICCs for device-specific complications such as catheter migration, dislodgement, breakage, phlebitis, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion and tamponade. Each complication is described, along with a review of the etiology, a description of presenting signs and symptoms, and key clinical interventions.
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Affiliation(s)
- Janet Pettit
- Neonatal Intensive Care Unit, Doctors Medical Center, 1441 Florida Ave, Modesto, CA 95350, USA.
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38
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Andrew ME, Monagle P, deVeber G, Chan AK. Thromboembolic disease and antithrombotic therapy in newborns. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2002:358-74. [PMID: 11722993 DOI: 10.1182/asheducation-2001.1.358] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This update uses an evidence based approach to analyze and present the epidemiology of neonatal thrombosis, etiologies, currently used techniques for diagnosis with their limitations, and current therapeutic approaches. In addition, the approaches to both prevention and optimal therapies are discussed. In Section I Dr. Paul Monagle addresses the epidemiology of neonatal thrombosis outside of the central nervous system in both arterial and venous locations, and those that occur in utero. The specific contributions of catheters and congenital prothrombotic disorders are delineated. Dr. Monagle also describes currently used techniques for the diagnosis of thrombotic events as well as their limitations and the current therapeutic approaches. In Section II, Dr. Gabrielle deVeber reviews the epidemiology of neonatal thrombosis within the central nervous system, in both arterial and venous locations and those that occur in utero. The neurological presentation, risk factors including congenital prothrombotic disorders, anatomical distribution, diagnostic tests, use of antithrombotic therapy and neurologic outcome of neonates with either sinovenous thrombosis or arterial ischemic stroke are discussed. In Section III, Dr. Anthony Chan reviews the current approaches to the prevention and treatment of neonatal thrombosis. Information on the differences in the response of neonates compared to adults to antithrombotic therapy and new approaches to the prevention and treatment of thrombosis in neonates are emphasized.
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Affiliation(s)
- M E Andrew
- Royal Children's Hospital, Department of Hematology, Victoria, Australia
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39
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Vignaux O, Gouya H, Dousset B, Mazuir E, Buffet C, Calmus Y, Legmann P. Refractory chylothorax in hepatic cirrhosis: successful treatment by transjugular intrahepatic portosystemic shunt. J Thorac Imaging 2002; 17:233-6. [PMID: 12082377 DOI: 10.1097/00005382-200207000-00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with cirrhosis and portal hypertension have increased thoracic duct lymph flow. Correction of portal hypertension is associated with decreases in thoracic duct flow. The authors present a case of rapid resolution of refractory chylothorax caused by thoracic duct injury proven by lymphangiography and helical CT scan in a patient with cirrhosis of the liver by using a transjugular intrahepatic portosystemic shunt to decrease portal pressure and thereby reduce thoracic duct lymph flow.
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40
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Kao CL, Chang JP. Chyle withdrawal from an implanted port in occult innominate vein stenosis. J Surg Oncol 2001; 78:138-40. [PMID: 11579393 DOI: 10.1002/jso.1134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Totally implantable venous devices are widely used for chemotherapy and parenteral nutrition. There have been many device-associated complications reported in the literature. Herein, we report a case of chyle withdrawal from an implanted port that occurred secondary to occult innominate vein stenosis in a patient receiving chemotherapy for rectal cancer with lung metastasis. The port remained patent and functioning well after balloon angioplasty.
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Affiliation(s)
- C L Kao
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC.
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41
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Gözdaşoğlu S, Unal E, Yavuz G. Should pericardial effusion be examined in patients presenting with chylothorax? J Pediatr 2001; 139:167-8. [PMID: 11445815 DOI: 10.1067/mpd.2001.115288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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42
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Affiliation(s)
- M P Massicotte
- Thrombosis Service, THe Hospital for Sick Children, University of Toronto, Canada.
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Drewett SR. Complications of central venous catheters: nursing care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2000; 9:466-8, 470-8. [PMID: 11143668 DOI: 10.12968/bjon.2000.9.8.6303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There are increasing numbers of patients, both at home and in the hospital, receiving intravenous therapy via long-term central venous catheters. Although fairly commonplace, there are many potential complications associated with the insertion and use of these catheters. This article describes the insertion and postinsertion-related complications of these devices. The article will give the nurse the information and confidence required for observing, detecting, preventing and/or treating promptly any complication to ensure the best possible nursing care.
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Affiliation(s)
- S R Drewett
- Parenteral Nutrition and Line Insertion Service, Oxford Radcliffe Hospitals Trust
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