Chylothorax In A Patient With A Peripherally Inserted Central Catheter And Multiple Pro-Thrombotic Risk Factors
INTRODUCTION: Chylothorax, caused by leakage of intestinal lymphatic fluid into the pleural cavity, is a known complication of thoracic surgery. Another cause, though rare, is upper extremity deep vein thrombosis (DVT). Peripherally inserted central catheters (PICC) significantly increase the risk of thrombotic events. Extreme caution should be taken when used in patients with pro-thrombotic risk factors.
CASE HISTORY: A 24-year-old female status post-hysterotomy for HELLP syndrome with post-operative fever, had a PICC placed in her right upper extremity for long-term intravenous antibiotics. The patient had a history of DVTs and repeated pre-eclampsia. Following PICC placement, she developed a PICC-associated right upper extremity DVT and bilateral exudative pleural effusion. The PICC was removed and she was discharged on anticoagulation therapy. Two weeks later, she developed a new left jugular and subclavian DVT secondary to subtherapeutic anticoagulation. Chest imaging revealed right pleural effusion. A thoracentesis drained 600 mL of cloudy, yellow fluid, and analysis confirmed the presence of a chylous effusion.
DISCUSSION: Our patient presented with multiple risk factors for DVT that were likely exacerbated by the insertion of a PICC, leading to subsequent chylothorax. Although the use of a PICC has benefits over other vascular devices for delivery of intravenous medication, the risks need to be carefully considered for a patient that exhibits an increased predisposition to DVT.