Bilateral chylothorax in a renal transplant recipient: case report and literature review.
Chylothorax is the accumulation of chyle in the pleural cavity as a result of damage to the lymphatic ducts. We treated a young man who was a kidney transplant recipient who had a prior internal jugular vein permanent catheter for hemodialysis, who developed dyspnea and hypoxemia. Chest radiography showed bilateral pleural effusion. Analysis of the white, milky, cloudy, odorless effusion fluid showed cell count > 500/μL; lymphocytes, 60%; total protein, 3.6 mg/dL; urea nitrogen, 45 mg/dL; creatinine, 90 μmol/L; triglycerides, above 2.2 mmol/L (repeatedly high); lactate dehydrogenase, 450 U/L (normal); and cultures, no growth. Magnetic resonance imaging showed thrombosis of the major neck veins, superior vena cava, and azygos vein. Treatment included pleural drains, gut rest, and dietary modification, octreotide, and warfarin. The chylothorax resolved with no relapse. In summary, chylothorax may occur in patients associated with thrombosis of major veins associated with a permanent dialysis catheter.
Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Area, Kuwait.
Osama
O
Gheith
Torki
T
Al Otaibi
M R N
MR
Nampoory
Hosam
H
Attia
Medhat
M
Halim
Tarek
T
Said
Prasad
P
Nair
Mohamed
M
Balaha
Waleed
W
Awadein
Zakaria
Z
Zakariya
Hasanein
H
Aboatteya
Nawas
N
Moideenkutty
D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002916:Chylothorax / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003131:Combined Modality Therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D016030:Kidney Transplantation; D018810:Magnetic Resonance Angiography; D008297:Male; D010690:Phlebography; D006435:Renal Dialysis; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000209:etiology*