title: Thrombolysis for central venous occlusion causing bilateral chylothorax in a patient with down syndrome.
abstract: A 20-year-old woman with Down syndrome (trisomy 21) and acute lymphoblastic leukemia presented with severe respiratory compromise secondary to bilateral chylothorax as a result of central venous thrombosis and extensive upper-limb deep venous thrombosis. The chylothorax was successfully managed by catheter-directed thrombolysis and angioplasty of the venous occlusions. The development of venous thrombosis was likely to have been multifactorial. It is recognized that there is an increased incidence of congenital lymphatic anomalies in Down syndrome, which may have been a contributing factor in the development of chylothorax in this patient. This report illustrates the angiographic findings, demonstrates the successful vascular recanalization, and discusses the etiology and management of central venous thrombosis and chylothorax. The case is also presented to contribute to the expanding evidence in support of catheter-directed venous thrombolysis in selected clinical circumstances.
authors.affiliation: Department of Diagnostic Radiology, Royal Cornwall Hospital Treliske, Truro, Cornwall, United Kingdom.
authors.forename: Nathan
authors.initials: N
authors.lastname: Manghat
authors.forename: John
authors.initials: J
authors.lastname: Hancock
authors.forename: Mark
authors.initials: M
authors.lastname: Walsh
authors.forename: Mark
authors.initials: M
authors.lastname: Puckett
authors.forename: Richard
authors.initials: R
authors.lastname: Noble
authors.forename: Simon
authors.initials: S
authors.lastname: Travis
mesh_terms: D000328:Adult; D017130:Angioplasty / Q000379:methods; D001367:Axillary Vein / Q000000981:diagnostic imaging; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D002916:Chylothorax / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D003287:Contrast Media / Q000008:administration & dosage; D004314:Down Syndrome / Q000150:complications*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D010690:Phlebography; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D013902:Radiography, Thoracic; D012131:Respiratory Insufficiency / Q000209:etiology; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D003287:Contrast Media; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator