Chyle leak in a hemodialysis tunneled catheter without associated chylothorax: An exceptional complication
El Kesri, Amine
Chyle leak in a hemodialysis tunneled catheter without associated chylothorax: An exceptional complication - 2025.
32
The presence of chyle in a hemodialysis catheter is a rare complication, usually observed in case of chylothorax secondary to central vein stenosis, particularly of the superior vena cava and the left brachiocephalic vein. We report the exceptional case of a 55-year-old woman in maintenance hemodialysis presenting with chyle in her left subclavian tunneled cuffed catheter during each interdialytic period, without any recent history of trauma or tumoral disease. The chest CT scan was unremarkable. The milky fluid was systematically observed by the nurses at the beginning of each hemodialysis session, before connection. The diagnosis of chyle was confirmed by a very high triglyceride concentration in the aspirated fluid, and the absence of biological and cytological arguments in favor of an infectious or tumoral pathology. A phlebography combining the opacification of the catheter and the left internal jugular vein revealed an aberrant trajectory of the catheter in an endothelial sheath, probably in communication with the outlet of the thoracic duct, which explains the leak of chyle. The removal of the tunneled catheter was followed by the insertion of a new one in the left internal jugular vein, taking a route outside the faulty endothelial sheath. This procedure resulted in complete resolution of the problem, with no recurrence at 10 months of follow-up. This is the first documented description of the presence of chyle in a tunneled catheter for hemodialysis, with no associated chylothorax nor central vein stenosis. This condition was due to a local mechanical complication, i.e., a communication between an aberrant path of the tunneled catheter within an endothelial sheath and the opening of the thoracic duct. We emphasize the importance of a complete phlebographic assessment in case of unexplained presence of chyle in a hemodialysis catheter.
Chyle leak in a hemodialysis tunneled catheter without associated chylothorax: An exceptional complication - 2025.
32
The presence of chyle in a hemodialysis catheter is a rare complication, usually observed in case of chylothorax secondary to central vein stenosis, particularly of the superior vena cava and the left brachiocephalic vein. We report the exceptional case of a 55-year-old woman in maintenance hemodialysis presenting with chyle in her left subclavian tunneled cuffed catheter during each interdialytic period, without any recent history of trauma or tumoral disease. The chest CT scan was unremarkable. The milky fluid was systematically observed by the nurses at the beginning of each hemodialysis session, before connection. The diagnosis of chyle was confirmed by a very high triglyceride concentration in the aspirated fluid, and the absence of biological and cytological arguments in favor of an infectious or tumoral pathology. A phlebography combining the opacification of the catheter and the left internal jugular vein revealed an aberrant trajectory of the catheter in an endothelial sheath, probably in communication with the outlet of the thoracic duct, which explains the leak of chyle. The removal of the tunneled catheter was followed by the insertion of a new one in the left internal jugular vein, taking a route outside the faulty endothelial sheath. This procedure resulted in complete resolution of the problem, with no recurrence at 10 months of follow-up. This is the first documented description of the presence of chyle in a tunneled catheter for hemodialysis, with no associated chylothorax nor central vein stenosis. This condition was due to a local mechanical complication, i.e., a communication between an aberrant path of the tunneled catheter within an endothelial sheath and the opening of the thoracic duct. We emphasize the importance of a complete phlebographic assessment in case of unexplained presence of chyle in a hemodialysis catheter.
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