# Superior Vena Cava Thrombosis Presenting As Massive Chylothorax: A Report of a Rare Case

## TL;DR

A rare case of massive chylothorax caused by chronic central venous thrombosis in a hemodialysis patient is reported, highlighting the condition's diagnostic challenges.

## Contribution

This paper presents a rare case linking central venous thrombosis to chylothorax in a hemodialysis patient.

## Key findings

- Chylothorax was confirmed via pleural fluid analysis and imaging in a patient with central venous catheter-related thrombosis.
- The case emphasizes the need for high suspicion of chylothorax in patients with central venous obstruction and relevant risk factors.
- A review of pathophysiology and treatment options is provided to guide clinical management.

## Abstract

Chylothorax is an uncommon condition resulting from the disruption or obstruction of the thoracic duct or its tributaries, leading to the accumulation of chyle in the pleural cavity. It can arise from both traumatic and non-traumatic causes. Non-traumatic etiologies include malignancies involving the mediastinum, followed by infections such as tuberculosis, connective tissue disorders (e.g., sarcoidosis, systemic lupus erythematosus), and, less frequently, radiation exposure and certain drugs. Although thoracic central venous thrombosis (CVT) is a recognized etiology, it remains a rare cause of chylothorax in adults. We report a rare case of massive chylothorax secondary to chronic CVT associated with a long-term indwelling central venous catheter in a patient undergoing hemodialysis for end-stage renal disease. The diagnosis of chylothorax was confirmed through pleural fluid analysis, which revealed characteristic findings, while the underlying cause was identified using targeted imaging modalities. This case highlights chylothorax's diagnostic complexity and clinical challenges in central venous obstruction. It also emphasizes the importance of maintaining a high index of suspicion in patients with relevant risk factors. A brief review of the underlying pathophysiology and available treatment approaches is also provided to aid clinicians in managing similar presentations.