A Case of Chylothorax Associated with Idiopathic Stenosis of Left Subclavian Vein in a Patient Undergoing Maintenance Hemodialysis

Korean Journal of Nephrology 2009;28(2):157-160.

Yu Min Lee, M.D., Hyun Jung Kim, M.D., Jeong Min Cha, M.D., Duk Eun Jung, M.D., Jae Hun Lee, M.D., Ji Eun Lee, M.D., Ju Hung Song, M.D. and Seon Ho Ahn, M.D.

Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea

증례 : 유지 혈액투석 중인 환자에서 특발성 쇄골하정맥 협착에 의해 발생한 유미흉 1예

이유민, 김현정, 차정민, 정덕은, 이재훈, 이지은, 송주흥, 안선호

원광대학교 의과대학 내과학교실

Abstract

Chylothorax is defined as the accumulation of chyle-containing lymphatic fluid within the pleural space. The causes of chylothorax are various and usually attributable to 1 of 4 categories: malignancy, trauma (including surgery), miscellaneous disorders, and idiopathy. Occurrence of chylothorax in patients on hemodialysis is very uncommon and it may have resulted from multiple iatrogenic vascular trauma conducive to venous thrombosis and stenosis when hemodialysis catheters required frequent changes or long term indwelling. Local thrombosis and stenosis may increase the venous hydrostatic pressure and hinder the discharge of thoracic duct lymph into the venous system. Hence, chylous lymphatic fluid leak into the pleural space. Treatment of chylothorax may range from nonoperative management to elective surgery. We report a case of a patient on hemodialysis who developed chylothorax secondary to a subclavian vein stenosis without any other symptoms such as arm edema and successfully treated with nonoperative management.

Key Words: Chylothorax, Hemodialysis, Subclavian vein