Central Venous Catheter-Related Extravasation Due to Delayed Vascular Erosion

Central venous catheters (CVCs) are crucial in critical care but may occasionally lead to rare, serious complications such as vascular erosion and extravasation of infused solutions. Leakage of total parenteral nutrition (TPN) into the pleural space can mimic chylothorax, potentially delaying correct diagnosis and appropriate treatment. An 83-year-old male with COVID-19-related acute respiratory distress syndrome (ARDS) received TPN via a left-sided CVC, which remained in a suboptimal position for 18 days. On day 18, he developed sudden respiratory deterioration associated with bilateral milky pleural effusions. Initially misdiagnosed as chylothorax, subsequent pleural fluid analysis revealed elevated glucose and triglyceride levels. Computed tomography demonstrated vascular erosion near the junction of the brachiocephalic vein and superior vena cava. The CVC was subsequently removed, enteral nutrition initiated, and the pleural effusions resolved. However, the patient eventually succumbed to progressive ARDS. This case highlights the risk of delayed vascular erosion associated with suboptimally positioned CVCs, highlighting the diagnostic difficulty posed by TPN extravasation mimicking chylothorax. Prompt recognition of this complication is crucial to prevent adverse outcomes.