Department of Radiology, CHU UCL Namur/Site Godinne, Yvoir, Belgium.
Department of Hematology, CHU UCL Namur/Site Godinne, Yvoir, Belgium.
Medicine (Baltimore). 2021 Dec 10;100(49):e28100. doi: 10.1097/MD.0000000000028100.
Central vein thrombosis is an uncommon cause of chylothorax, usually secondary to central venous catheterization in association with prothrombotic state causes such as malignancies. In the following case, thrombosis was located in the left brachiocephalic vein and caused recurrent chylothorax resistant to the first line of treatment and successfully treated by percutaneous recanalization using a dual approach.
A 52-year-old male patient with current follicular lymphoma undergoing treatment and recent history of COVID-19 pulmonary infection was hospitalized for dyspnea. A chest X-ray revealed extensive bilateral pleural effusion. Analysis of the pleural fluid was compatible with a chylothorax. Iodin injected thoracic computed tomography (CT) revealed a complete left brachiocephalic thrombosis extending to the left axillary vein, with no thoracic mass.
Chylothorax due to left brachiocephalic vein thrombosis.
Following an unsuccessful first line of treatment consisting of a low-fat diet, somatostatins and anticoagulation medication, the patient was elected to undergo minimally invasive venous recanalization with stenting. After a first failed attempt of recanalization by femoral access, we successfully crossed the thrombus through brachial access and conducted a dilatation and stenting of the brachiocephalic vein by femoral access, using a "telepheric" method.
During the 4-month follow up, PET-scanner and chest X-ray demonstrated a significant reduction of the pleural effusion, and the patient reported complete clinical recovery.
Central vein thrombosis is an unusual cause of chylothorax. We report a case of chylothorax complicating a brachiocephalic vein thrombosis successfully treated by percutaneous recanalization and stenting using a dual brachial and femoral approach. No thoracic duct embolization or ligature was required.
中心静脉血栓形成是乳糜胸的一种罕见病因，通常继发于中心静脉置管，同时存在易栓状态等原因，如恶性肿瘤。在以下病例中，血栓位于左头臂静脉，导致复发性乳糜胸，对一线治疗无效，经皮双入路再通治疗成功。
一名 52 岁男性患者，目前患有滤泡性淋巴瘤，正在接受治疗，近期患有 COVID-19 肺部感染，因呼吸困难住院。胸部 X 线片显示广泛双侧胸腔积液。胸腔积液分析符合乳糜胸。碘注入胸部计算机断层扫描（CT）显示完全性左头臂静脉血栓形成，延伸至左腋静脉，无胸部肿块。
左头臂静脉血栓形成致乳糜胸。
一线治疗包括低脂饮食、生长抑素和抗凝药物，但治疗失败，随后患者选择微创静脉再通和支架置入。首次经股动脉入路再通失败后，我们成功通过肱动脉入路穿过血栓，并经股动脉入路进行头臂静脉扩张和支架置入，采用“远程”方法。
在 4 个月的随访中，PET 扫描和胸部 X 线片显示胸腔积液明显减少，患者报告完全临床康复。
中心静脉血栓形成是乳糜胸的一种不常见病因。我们报告一例头臂静脉血栓形成合并乳糜胸，经皮双入路（肱动脉和股动脉）再通和支架置入成功治疗。不需要进行胸导管栓塞或结扎。
