title: Pseudochylothorax and diaphragmatic weakness secondary to a misplaced central venous catheter.
abstract: A 20-year-old woman admitted with an aspirin overdose was encephalopathic and was intubated for airway protection. Under sonographic guidance, a right internal jugular central venous catheter was inserted for volume resuscitation. She was agitated and required treatment with a propofol infusion. Her salicylate levels improved and she was successfully extubated 12 h after intubation. One day later she developed severe dyspnoea and a right-sided pleural effusion and required immediate reintubation. The effusion was drained and was consistent with a chylothorax. A CT scan of the chest revealed that the central venous catheter traversed the mediastinum with its tip in the right pleural space. The propofol infusion was draining into the pleural space. A video-assisted thoracoscopic surgery was performed to drain the pleural effusion and repair the punctured vessel. She was extubated within a day and discharged home 1 day later without any pleural fluid.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA.
authors.forename: Hari Krishna
authors.initials: HK
authors.lastname: Puttagunta
authors.forename: Chanaka
authors.initials: C
authors.lastname: Seneviratne
authors.forename: Yizhak
authors.initials: Y
authors.lastname: Kupfer
authors.forename: Sidney
authors.initials: S
authors.lastname: Tessler
mesh_terms: D001241:Aspirin / Q000506:poisoning; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002916:Chylothorax / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D004322:Drainage; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D010996:Pleural Effusion / Q000209:etiology / Q000601:surgery / Q000628:therapy; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D020775:Thoracic Surgery, Video-Assisted; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D001241:Aspirin; D015742:Propofol