Povidone-iodine pleurodesis for congenital chylothorax in an infant: A case report

Abstract

Introduction

Chylothorax in infants can be classified into five types: congenital, traumatic, postoperative, embolic, and spontaneous, the last one being the most common one. Its etiology is not fully understood, it has a relatively high mortality rate, and there are no standardized guidelines regarding its treatment.

Case presentation

A I-month-old infant presented with worsening shortness of breath, without fever or any signs of an airway infection. A chest X-ray revealed a large right pleural effusion causing mediastinal shift. The fluid was drained with a 7Fr central venous catheter placed in the right pleural cavity and left as a chest tube. The fluid that was drained had a milky appearance, suggestive of chylothorax. Fluid analysis confirmed elevated triglycerides. The patient was initially managed with total parenteral nutrition (TPN). The chest tube drained several hundred milliliters per day. On the fifth day of hospitalisation, we initiated a plan of chemical pleurodesis using a combination of 2 mL of povidone-iodine, 2 mL of lidocaine, and 8 mL of normal saline, administered through the chest drain. The chest tube was clamped and the patient rotated frequently. The chest tube was clamped for about an hour and undamped thereafter. The procedure was repeated every other day, the last one being on the twelfth day of hospitalisation. The output of the chest tube decreased rapidly, and the chest tube was removed on the fifteenth day of hospitalisation. The patient was discharged after seventeen days of hospitalisation with near complete resolution of the chylothorax.

Conclusion

Chemical pleurodesis with povidone-iodine seems to be an effective management option for infants with congenital chylothorax.