Direct percutaneous access of the thoracic duct in a neonate as curative treatment of a high-output life-threatening chylothorax due to thrombotic occlusion of the thoracic duct–venous junction

A life-threatening chylothorax developed in a female neonate after corrective surgery of d-transposition of the great arteries complicated by extensive postoperative thrombosis of the superior vena cava distribution, including at the thoracic duct-venous junction. Emergent percutaneous catheter intervention for thrombus aspiration and transluminal angioplasty was required. Despite therapeutic heparinization, thrombosis persisted. Curative image-guided treatment was twofold: first, the occluded thoracic duct was punctured under ultrasound guidance; then, the thrombus at the thoracic duct-venous junction was mobilized using the Seldinger-technique. Additionally, a venous catheter was placed with the tip at the thoracic duct-venous junction, and local low-dose thrombolysis was administered. This case shows that it is possible to percutaneously access the thoracic duct by direct puncture in a neonate with ultrasound guidance.