Direct percutaneous access of the thoracic duct in a neonate as curative treatment of a high-output life-threatening chylothorax due to thrombotic occlusion of the thoracic duct-venous junction.

IF 2.3 3区医学 Q2 PEDIATRICS

Pediatric Radiology Pub Date : 2025-10-02 DOI:10.1007/s00247-025-06412-1

Daniel Kronenberg, Hitendu Dave, Oliver Kretschmar, Alessandra Bosch, Janet Kelly-Geyer, Christian Johannes Kellenberger, Ralph Gnannt

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引用次数: 0

Abstract

A life-threatening chylothorax developed in a female neonate after corrective surgery of d-transposition of the great arteries complicated by extensive postoperative thrombosis of the superior vena cava distribution, including at the thoracic duct-venous junction. Emergent percutaneous catheter intervention for thrombus aspiration and transluminal angioplasty was required. Despite therapeutic heparinization, thrombosis persisted. Curative image-guided treatment was twofold: first, the occluded thoracic duct was punctured under ultrasound guidance; then, the thrombus at the thoracic duct-venous junction was mobilized using the Seldinger-technique. Additionally, a venous catheter was placed with the tip at the thoracic duct-venous junction, and local low-dose thrombolysis was administered. This case shows that it is possible to percutaneously access the thoracic duct by direct puncture in a neonate with ultrasound guidance.

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直接经皮胸导管入路治疗新生儿因胸导管-静脉连接处血栓闭塞导致的高输出量危及生命的乳糜胸。

一名女性新生儿在大动脉d转位矫正手术后出现危及生命的乳糜胸，并伴有术后广泛的上腔静脉分布血栓形成，包括在胸导管-静脉交界处。急诊经皮导管介入治疗血栓抽吸和腔内血管成形术是必需的。尽管肝素治疗，血栓仍然存在。影像引导下的治疗分为两步：一是在超声引导下穿刺阻塞的胸导管；然后用seldinger技术将胸导管-静脉交界处的血栓动员起来。此外，将静脉导管的尖端放置在胸导管-静脉交界处，并给予局部低剂量溶栓。本病例表明，在超声引导下，经皮直接穿刺新生儿胸导管是可能的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Radiology 医学-核医学

CiteScore

4.40

自引率

17.40%

发文量

300

审稿时长

3-6 weeks

期刊介绍： Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.