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Bilateral chylothorax in a newborn

M R Curci, A W Dibbins

    Journal of Pediatric Surgery
    |October 1, 1980
    PubMed

    Insights

    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.

    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.
    • 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.

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