| Title: |
A 66-Year-Old Man with Intrapleural Leakage of Parenteral Nutrition Fluid Due to a Malpositioned Central Venous Catheter. |
| Authors: |
Van Herck, Jakob; Snoeck, Wouter; Vanhoof, Marc; Van Damme, Helena; Decoster, Lynn |
| Source: |
American Journal of Case Reports; 8/14/2025, Vol. 26, p1-5, 5p |
| Subject Terms: |
CENTRAL venous catheters; PARENTERAL feeding; WATER leakage; PLEURAL effusions; CRITICAL care medicine; SEPTIC shock |
| Abstract: |
Patient: Male, 66-year-old Final Diagnosis: Leakage of parenteral nutrition in the pleural space Symptoms: Patient under sedation; need to increase the fraction of inspired oxygen during mechanical ventilation Clinical Procedure: Chest drain * CVC placement Specialty: Critical Care Medicine * Nutrition and Dietetics * Pulmonology Objective: Rare disease Background: Total parenteral nutrition (TPN) can be indicated when oral and enteral intake are not feasible. TPN requires central venous access. This case describes a 66-year-old man with intrapleural leakage of TPN, due to a malpositioned central venous catheter. Case Report: A 66-year-old man was admitted to the Intensive Care Unit (ICU) with septic shock due to cholangitis. On admission to the ICU, a central venous catheter (CVC) was placed in the left internal jugular vein. On day 4, TPN was started because of gastrointestinal intolerance to enteral feeding. On day 5, he developed a bilateral pleural effusion. A pig tail catheter was placed in the left pleural space, draining 2.5 L of a white, milky fluid. Analysis of the fluid showed a transudate according to Light's criteria, high triglyceride levels of 789 mg/dL, but also notably elevated glucose levels of 772 mg/dL, whereby TPN leakage in the pleural cavity was suspected. Radiography while injecting intravenous contrast in the CVC showed contrast extravasation in the upper mediastinum. Conclusions: This report highlights an uncommon complication of TPN and aims to raise awareness of the possibility of TPN fluid leak into the pleural space from a malpositioned CVC. In a patient who develops pleural effusion while receiving TPN, analysis of pleural fluid triglyceride, glucose, and potassium levels can aid in establishing the diagnosis. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |