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Case Reports
. 2025 Jun 4;30(13):103882.
doi: 10.1016/j.jaccas.2025.103882.

Chylothorax After Single-Chamber Implantable Cardioverter-Defibrillator Extraction

Marco Radaelli  1 , Mohammad Saad Husain  2 , Julian Armijo-Alba  2 , Joshua Alan Makepeace  3 , Cyrus Hadadi  3 , Benjamin B Kenigsberg  4
Affiliations
Case Reports

Chylothorax After Single-Chamber Implantable Cardioverter-Defibrillator Extraction

Marco Radaelli et al. JACC Case Rep. .

Abstract

Background: Cardiac implantable electrical device (CIED) lead extraction is increasingly common, with up to 15,000 cases annually. Although the procedure is generally safe, complications can occur, and knowledge of potential issues is essential for patient care.

Case summary: A 63-year-old man with multiple comorbidities underwent implantable cardioverter-defibrillator lead extraction as a result of device pocket infection. Post-procedure, he developed worsening hypoxic respiratory failure. Imaging revealed a new right-sided pleural effusion, which on drainage was confirmed as chylothorax. Despite initial improvement with conservative management, the patient's condition deteriorated, leading to cardiac arrest and eventual death.

Discussion: This case presents the first reported instance of chylothorax complicating CIED lead extraction. It highlights the importance of considering rare complications in postprocedural care, especially in patients with complex medical histories.

Take-home messages: Chylothorax should be considered in patients with new pleural effusions following CIED lead extraction. Early recognition and appropriate management of rare complications are crucial in high-risk patients.

Keywords: cardiac pacemaker; chronic heart failure; chylothorax; pleural effusion; reduced ejection fraction; systolic heart failure.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Right-Sided Swan-Ganz Catheter With the Tip Extending to the Main Pulmonary Trunk A single-lead pacemaker and minimal interstitial edema with scattered atelectasis are visible. AP = anteroposterior; R = right.
Figure 2
Figure 2
Moderately Sized Right-Sided Pleural Effusion With Opacity at the Right Lower Lung Base
Figure 3
Figure 3
Moderate Right-Sided Pleural Effusion on Computed Tomography Scan
Figure 4
Figure 4
Thoracic Duct Anatomy Anterior view of the thoracic duct and its relationship with the venous systems in the superior thoracic and subclavian regions The thoracic duct is seen at its entry point at the junction between the left subclavian vein and the internal jugular vein.
See this image and copyright information in PMC

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