Chylothorax due to central vein thrombosis treated by venous stenting using a dual approach: A case report

RATIONALE: Central vein thrombosis is an uncommon cause of chylothorax, usually secondary to central venous catheterization in association with prothrombotic state causes such as malignancies. In the following case, thrombosis was located in the left brachiocephalic vein and caused recurrent chylothorax resistant to the first line of treatment and successfully treated by percutaneous recanalization using a dual approach. PATIENT CONCERNS: A 52-year-old male patient with current follicular lymphoma undergoing treatment and recent history of COVID-19 pulmonary infection was hospitalized for dyspnea. A chest X-ray revealed extensive bilateral pleural effusion. Analysis of the pleural fluid was compatible with a chylothorax. Iodin injected thoracic computed tomography (CT) revealed a complete left brachiocephalic thrombosis extending to the left axillary vein, with no thoracic mass. DIAGNOSES: Chylothorax due to left brachiocephalic vein thrombosis. INTERVENTIONS: Following an unsuccessful first line of treatment consisting of a low-fat diet, somatostatins and anticoagulation medication, the patient was elected to undergo minimally invasive venous recanalization with stenting. After a first failed attempt of recanalization by femoral access, we successfully crossed the thrombus through brachial access and conducted a dilatation and stenting of the brachiocephalic vein by femoral access, using a “telepheric” method. OUTCOMES: During the 4-month follow up, PET-scanner and chest X-ray demonstrated a significant reduction of the pleural effusion, and the patient reported complete clinical recovery. LESSONS: Central vein thrombosis is an unusual cause of chylothorax. We report a case of chylothorax complicating a brachiocephalic vein thrombosis successfully treated by percutaneous recanalization and stenting using a dual brachial and femoral approach. No thoracic duct embolization or ligature was required.