Case Report of Needle Disruption of the Retroperitoneal Lymph Nodes for Refractory Chylothorax After Double Lung Transplantation

Hiroshi Kagawa; John Stringham; Craig Selzman; Matthew Goodwin; Laura Frye; Sanjeev Raman; Barbara Cahill; Matthew Morrell

doi:10.1016/j.transproceed.2023.08.003

Case Report of Needle Disruption of the Retroperitoneal Lymph Nodes for Refractory Chylothorax After Double Lung Transplantation

Transplant Proc. 2023 Oct;55(8):1981-1983. doi: 10.1016/j.transproceed.2023.08.003. Epub 2023 Aug 31.

Authors

Hiroshi Kagawa¹, John Stringham², Craig Selzman², Matthew Goodwin², Laura Frye³, Sanjeev Raman³, Barbara Cahill³, Matthew Morrell³

Affiliations

¹ Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: [email protected].
² Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
³ Department of Internal Medicine, Division of Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, Utah.

PMID: 37658010
DOI: 10.1016/j.transproceed.2023.08.003

Abstract

Chylothorax is a rare complication after double lung transplantation. We report a case of a 55-year-old man with idiopathic pulmonary fibrosis. He underwent a double lung transplantation with venoarterial extracorporeal membrane support. The surgery was uncomplicated; however, his postoperative course was complicated with a refractory chylothorax that started postoperative day 4. Medical management could not control the chylothorax, including nil per os, total parenteral nutrition, and octreotide administration. After failed percutaneous embolization via lymphangiography and surgical ligation of the thoracic duct and pleurodesis via video-assisted thoracoscopic surgery, percutaneous needle disruption of the retroperitoneal lymph nodes was performed. After this procedure, the chylothorax resolved quickly. Percutaneous needle disruption of the retroperitoneal lymph node is safe and effective for refractory chylothorax. This technique can be one of the main modalities to manage chylothorax after lung transplantation.