Contralateral Chylothorax: One More Complication of subclavian Venous Puncture

Abstract

To the Editor:In June 1983, Ciment et al reported two cases of contralateral effusions secondary to subclavian venous catheters (Chest 1983; 83:926–27). We recently observed right chylothorax in a 75-year-old man 15 days after problematic insertion of a definitive endovenous pacemaker into the left subclavian vein. Other potential causes of chylothorax, especially neoplasm, were excluded. The chylothorax resolved spontaneously and did not recur.To our knowledge, this is the first report of a chylothorax secondary to endovenous pacemaker insertion (Acta Clin Belgica, in press). However, subclavian vein puncture has already been mentioned by Marsac as a possible cause of chylothorax.1Marsac J. Frija G. Bismuth V. Chylothorax et pathologie lymphatique de la plèvre.Rev fr Mal Resp. 1982; 10: 227-241PubMed Google Scholar The mechanism is similar to that described by Ciment et al. Mediastinal leakage of chyle occurs first, and the pleural effusion (homolateral or contralateral) may appear as late as two weeks after the puncture, as in our case. As central venous catheters are used more and more, it is important to be aware of potential complications, either classic or rare. Late-appearing contralateral effusion or chylothorax may represent a diagnostic challenge. As Ciment et al point out, the more frequent use of right internal jugular vein for central catheters may significantly reduce complications, and subclavian venous catheters should be reserved for emergencies or profoundly hypovolemic patients.2Stevens J.C. Hamit H.F. A simple method for percutaneous cannulation of the internal jugular vein.Am J Surg. 1978; 135: 722-723Abstract Full Text PDF PubMed Scopus (7) Google Scholar Pneumothoraces and hydrothoraces are less frequent with the internal jugular vein approach and chylothorax has not been reported using this insertion route.3Bernard R.W. Stahl W.M. Subclavian vein catheterization: a prospective study.Ann Surg. 1971; 173: 184-200Crossref PubMed Scopus (216) Google Scholar To the Editor: In June 1983, Ciment et al reported two cases of contralateral effusions secondary to subclavian venous catheters (Chest 1983; 83:926–27). We recently observed right chylothorax in a 75-year-old man 15 days after problematic insertion of a definitive endovenous pacemaker into the left subclavian vein. Other potential causes of chylothorax, especially neoplasm, were excluded. The chylothorax resolved spontaneously and did not recur. To our knowledge, this is the first report of a chylothorax secondary to endovenous pacemaker insertion (Acta Clin Belgica, in press). However, subclavian vein puncture has already been mentioned by Marsac as a possible cause of chylothorax.1Marsac J. Frija G. Bismuth V. Chylothorax et pathologie lymphatique de la plèvre.Rev fr Mal Resp. 1982; 10: 227-241PubMed Google Scholar The mechanism is similar to that described by Ciment et al. Mediastinal leakage of chyle occurs first, and the pleural effusion (homolateral or contralateral) may appear as late as two weeks after the puncture, as in our case. As central venous catheters are used more and more, it is important to be aware of potential complications, either classic or rare. Late-appearing contralateral effusion or chylothorax may represent a diagnostic challenge. As Ciment et al point out, the more frequent use of right internal jugular vein for central catheters may significantly reduce complications, and subclavian venous catheters should be reserved for emergencies or profoundly hypovolemic patients.2Stevens J.C. Hamit H.F. A simple method for percutaneous cannulation of the internal jugular vein.Am J Surg. 1978; 135: 722-723Abstract Full Text PDF PubMed Scopus (7) Google Scholar Pneumothoraces and hydrothoraces are less frequent with the internal jugular vein approach and chylothorax has not been reported using this insertion route.3Bernard R.W. Stahl W.M. Subclavian vein catheterization: a prospective study.Ann Surg. 1971; 173: 184-200Crossref PubMed Scopus (216) Google Scholar