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Case Reports
. 2013 Apr 18:2013:bcr2013008765.
doi: 10.1136/bcr-2013-008765.

Pseudochylothorax and diaphragmatic weakness secondary to a misplaced central venous catheter

Hari Krishna Puttagunta  1 , Chanaka Seneviratne, Yizhak Kupfer, Sidney Tessler
Affiliations
Case Reports

Pseudochylothorax and diaphragmatic weakness secondary to a misplaced central venous catheter

Hari Krishna Puttagunta et al. BMJ Case Rep. .

Abstract

A 20-year-old woman admitted with an aspirin overdose was encephalopathic and was intubated for airway protection. Under sonographic guidance, a right internal jugular central venous catheter was inserted for volume resuscitation. She was agitated and required treatment with a propofol infusion. Her salicylate levels improved and she was successfully extubated 12 h after intubation. One day later she developed severe dyspnoea and a right-sided pleural effusion and required immediate reintubation. The effusion was drained and was consistent with a chylothorax. A CT scan of the chest revealed that the central venous catheter traversed the mediastinum with its tip in the right pleural space. The propofol infusion was draining into the pleural space. A video-assisted thoracoscopic surgery was performed to drain the pleural effusion and repair the punctured vessel. She was extubated within a day and discharged home 1 day later without any pleural fluid.

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Figures

Figure 1
Figure 1
Chest x-ray of the misplaced central venous catheter. Arrow points to the gentle curve of the catheter from medial to lateral.
Figure 2
Figure 2
CT scan reveals misplaced central venous catheter and right pleural effusion.
Figure 3
Figure 3
Chest x-ray showing elevation of the right hemidiaphragm.
See this image and copyright information in PMC

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