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Related Experiment Videos

Bilateral chylothorax in a newborn.

M R Curci, A W Dibbins

    Journal of Pediatric Surgery
    |October 1, 1980
    PubMed
    Summary
    This summary is machine-generated.

    Superior vena cava (SVC) thrombosis in an infant led to significant bilateral chylothorax, causing extreme fluid loss. Surgical intervention with parietal pleurectomy successfully resolved the condition.

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    Area of Science:

    • Pediatrics
    • Cardiovascular Surgery
    • Thoracic Surgery

    Background:

    • Superior vena cava (SVC) thrombosis is a rare but serious complication in infants, often associated with indwelling central venous catheters.
    • Chylothorax, the accumulation of lymphatic fluid in the pleural space, can lead to significant nutritional and fluid imbalances.

    Observation:

    • A 1.6-kg infant developed bilateral chylothorax secondary to SVC thrombosis after placement of a silastic catheter.
    • The infant experienced substantial daily fluid loss (240 ml/day), exceeding 1.7 times the patient's blood volume, requiring extensive fluid replacement with fresh frozen plasma.
    • Despite supportive care, including peripheral intravenous nutrition and maintaining an NPO (nothing by mouth) status, the chylothorax persisted for 3 weeks.

    Findings:

    • A thoracotomy was performed due to the persistent chylothorax and lack of improvement.

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  • A parietal pleurectomy was chosen as the surgical approach in the absence of a clearly identifiable chyle leak site.
  • The chylothorax resolved immediately after the surgical procedure.

    • Implications:

    • This case highlights an unusual presentation of SVC thrombosis leading to massive chylothorax in an infant.
    • Parietal pleurectomy can be an effective surgical strategy for managing refractory chylothorax, even without a localized leak identification.
    • The management of such extreme fluid loss necessitates aggressive fluid resuscitation and careful monitoring.