Retrograde Transvenous Thoracic Duct Embolization for Tubercular Chylothorax

TL;DR

A 27-year-old man with tubercular chylothorax was successfully treated with a novel embolization procedure after standard therapies.

Contribution

The use of retrograde transvenous thoracic duct embolization with NBCA glue for tubercular chylothorax is highlighted as a novel treatment approach.

Findings

The patient was diagnosed with chylothorax caused by hemophagocytic lymphohistiocytosis and tubercular lymphadenopathy.

Retrograde transvenous thoracic duct embolization using NBCA glue effectively managed the chylothorax.

Collaborative care and monitoring enabled successful removal of the drainage tube and patient discharge.

Abstract

This case study documents the clinical profile of a 27-year-old male patient who visited the medical facility two months ago with complaints of dry cough, fatigue, weight loss, and occasional fever. He had been treated for ascites and pleural effusion in the hospital before presentation and returned with an intercostal drain in place. A detailed examination revealed symptoms of respiratory disorders, including fluid in both lungs, fever, and dyspnea. His fluid levels showed multiple deviations from the normal range, according to the report's findings and lab test results. It was determined that the patient had chylothorax, which resulted from hemophagocytic lymphohistiocytosis (HLH) and abdominal tubercular lymphadenopathy. His anti-tubercular treatment (AKT4) was initiated, along with octreotide for his management. Initial management included non-invasive ventilator (NIV) support, intravenous antibiotics, nebulization, and an intercostal chest drain (ICD). Later, the patient underwent retrograde transvenous thoracic duct embolization (TDE) using N-butyl cyanoacrylate (NBCA) glue. The removal of the drainage tube and the patient’s stable discharge were made possible through regular monitoring and collaboration between specialists.

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