Lethal chylothoraces due to superior vena caval thrombosis in infants

An unusual etiology, probably iatrogenic, for chylothoraces in the newborn period was recently noted. Three tiny premature infants, all of whom subsequently died, developed massive bilateral chylothoraces. These infants had had prolonged hyperalimentation using jugular central venous catheters for severe gastrointestinal problems and malnutrition. All developed superior vena caval thrombosis, two with overt superior vena caval syndromes. Two had venograms that showed extension of thrombus into the innominate veins to the confluence of the jugular and subclavian veins, at the site of drainage of the lymphatic channels of the thorax. The relationship between superior vena caval an innominate vein thrombosis and chylothoraces in discussed and an important pitfall in the radiologic evaluation is emphasized.