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<p>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.</p>

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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

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  • 发表日期：

    2025年10月2日

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

摘要

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.