Abstract Introduction Chylothorax is a rare condition defined by the presence of chyle into the pleural space, typically, it results from leakage of the lymphatic system. A chylothorax can be associated with significant morbidity and mortality if the underlying cause is not addressed 1. The most common etiologies for chylothoraxes have been described secondary to surgical intervention, blunt trauma, or non-traumatic from underlying malignancy 2,3.Injury to the thoracic duct is the most common site to cause a chylothorax. In this case we identified a patient who developed a large pleural effusion following tunneled dialysis catheter exchange, subsequently found to be a chylothorax. Case Report A 59-year-old male with a medical history of vertebral osteomyelitis, opiate use disorder, systolic heart failure, and end stage renal disease presented with dyspnea initially attributed to missing a hemodialysis session, found to have a new large left sided pleural effusion on presenting chest radiograph (Figure 1). A thoracentesis was performed with 1500ml of milky white fluid removed (Figure 2). Pleural fluid studies were demonstrated an exudative effusion with total protein of 11g/dL and triglyceride of 2052mg/dL, consistent with a diagnosis of chylothorax. Cytology and culture were negative for malignancy or infection, respectively. The chylothorax was noted to recur within 48 hours of initial drainage. Chart review demonstrated that the patient had a recently undergone a tunneled dialysis catheter exchange with the proceduralist noting technical difficulty. During the procedure, the catheter was found within azygous vein, and it required several attempts to advance past the superior vena cava.Given the recurrence interventional radiology was consulted for lymphangiogram with thoracic duct embolization, following which there was no recurrence of the chylothorax. Discussion Chylothorax is rare and when encountered are often secondary to trauma or malignancy 1. Iatrogenic causes can be from surgery or catheter placement. Catheter associated chylothorax have been seen, although rarely, and when noted are usually in the setting of catheter thrombosis 1,4. This case uniquely demonstrates a patient who underwent tunneled dialysis catheter exchange without other documented trauma to the area, and no evidence of thrombosis which is the typical presentation for chylothorax associated with central venous catheters. This case highlights the risk of iatrogenic chylothorax following tunneled catheter placement and demonstrates successful treatment of the condition that if left untreated has significant morbidity and mortality. This abstract is funded by: None
Moseley et al. (Fri,) studied this question.