Left Chylothorax Associated with Hemodialysis Treatment: Clinical Case

Abstract

Introduction: Chylothorax is the accumulation of chyle in the pleural space. Thoracentesis confirmed a triglyceride concentration of more than 110 mg/dL or positive chylomicrons in the pleural fluid. Chylothorax formation has an extensive list of traumatic and non-traumatic etiologies. Approximately 50% of cases of chylothorax are due to traumatic etiologies and can classified as surgical causes, with esophagectomy and corrective operations for congenital heart disease being the most common and non-surgical causes, such as chest radiation and blunt trauma. Clinical Case: A 60-year-old female with the following history: transfusions seven times due to Chronic Kidney Disease (CDK). Surgeries: complicated cholecystectomy that caused acute tubular necrosis, which did not recover function, and replacement treatment with hemodialysis. Diabetes Mellitus 2 type and Hypertension Arterial for 18 years. CKD in usual treatment. Hemodialysis three sessions per week QS 300 QD 500, Na 138 K2, Ca2 Temp: 36^o C, HCO₃ 38 uf adjust dry weight 51.0, heparin 1000 IU bolus and 500 IU maintenance, filter 18 kt/v 1.2, seal with pure heparin. Discussion: The internal jugular vein is an essential option for central venous access for many different purposes, including hemodialysis. The internal jugular vein and the other cephalic veins undergo a complicated process of embryonic development, with innumerable opportunities for abnormal development, regressions, or anastomoses, creating many different anatomical variants. Conclusions: The chylothorax in this patient was due to an accident when puncturing the vein, which is not uncommon, and these procedures are performed by trained personnel and with the support of ultrasound guidance. However, the subclavian access is used more in our service.