Korean J Crit Care Med.  2015 Nov;30(4):343-348. 10.4266/kjccm.2015.30.4.343.

Central Venous Catheter-Related Hydrothorax

• Kim SH
• Her C

• KMID: 2156192
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.343

Abstract

This report describes a case of 88-year-old women who developed central venous catheter-related bilateral hydrothorax, in which left pleural effusion, while right pleural effusion was being drained. The drainage prevented accumulation of fluid in the right pleural space, indicating that there was neither extravasation of infusion fluid nor connection between the two pleural cavities. The only explanation for bilateral hydrothorax in this case is lymphatic connections. Although vascular injuries by central venous catheter can cause catheter-related hydrothorax, it is most likely that the positioning of the tip of central venous catheter within the lymphatic duct opening in the right subclavian-jugular confluence or superior vena cava causes the catheter-related hydrothorax. Pericardial effusion can also result from retrograde lymphatic flow through the pulmonary lymphatic chains.

Keyword

central venous catheter; lymphatic system; pleural effusion

MeSH Terms

Aged, 80 and over
Central Venous Catheters
Drainage
Female
Humans
Hydrothorax*
Lymphatic System
Pericardial Effusion
Pleural Cavity
Pleural Effusion
Vascular System Injuries
Vena Cava, Superior

Figure

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  Fig. 1. An unremarkable plain chest radiograph taken during the immediate postoperative period.

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  Fig. 2. Plain chest radiograph taken in the evening of the first postoperative day, several hours after insertion of a left subclavian central venous catheter, showing acceptable positioning of the catheter and a mild to moderate amount of right pleural effusion.

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  Fig. 3. Plain chest radiograph taken in the morning of the second postoperative day, showing the collapsed entire right lung with a large amount of right pleural effusion.

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  Fig. 4. Plain chest radiograph taken in the morning of the third postoperative day, showing a clear lung field on both sides and a chest tube on the right side.

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  Fig. 5. Plain chest radiograph taken in the morning of the fourth postoperative day, showing a large amount of left pleural effusion. The U-shaped tube in the middle of mediastinum, also shown in Fig. 4, was a kinked nasogastric tube, which was removed. A new nasogastric tube was inserted correctly.

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  Fig. 6. The lymphatic ducts of the right para-tracheobronchial lymph node chains, which drain lung lymph directly into the jugulo-subclavian venous confluence. PTD denotes right paratracheal chain, ITB intertracheobronchial lymph nodes, BSG left superior bronchial lymph node, and RH beginning of the left recurrent chain (Adopted from Le Pimpec Barthes F, et al,[10] with permission from the authors and publisher).

Reference

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