Bidirectional approach of vascular access for balloon angioplasty in permcath-associated superior vena cava syndrome presenting with transudative chylothorax

Chylothorax is characterized by lymphatic fluid accumulation in the pleural cavity caused by thoracic duct and lymphatic drainage disruption. Most cases of chylothorax are lymphocyte-predominant exudative pleural effusions with high protein, low lactate dehydrogenase (LDH), and elevated triglyceride levels [1]. Prompt evaluations for underlying causes are key to resolve chylothorax and avoid recurrence. Herein, we report the case of a 4-year-6-month-old girl who had been receiving regular hemodialysis via a left subclavian vein permcath with the tip in the right atrium since 6 months old.