PO-04-059 THORACIC DUCT LEAK AFTER DEFIBRILLATOR IMPLANTATION

Device implantation is a relatively low-risk procedure, however generator pocket complications can still occur. In this case, the device site was complicated by thoracic duct chylous extravasation leading to lymphatic drainage into pocket. Case Report A 55-year-old male with ischemic congestive heart failure and reduced ejection fraction of 30-35% left bundle branch block >150 milliseconds presented several months after cardiac resynchronization therapy-defibrillation (CRT-D) swelling. The physical exam notable for an extremely swollen arm consistent lymphedema. This swelling slowly enlarged past 6 implantation. Concern complication evolving hematoma that caused compressive lymph stasis. Decision made extraction reimplantation. Pictured below (Figure 1) shows actually filled fluid. Upon further investigation, either damaged or obstructed likely culprit. then evacuated subsequent No immediate were noted. follow-up, normal, lymphedema resolved. case demonstrates rare does not appear be reported in our literature search. Typically hematoma, infection, erosion, migration, Twiddler’s Syndrome are most common pockets. typically runs from superior aspect cisterna chyli which situated at L2 vertebrae lower cervical spine. Termination 95% patients internal jugular vein, subclavian angle between them. However, termination posterior without superficial course. Lymphatic obstruction tends late presenting easily confused venous delays care. Management usually removing obstructive source, however, low fat diet has shown benefit. Thoracic but lead delayed treatment repeat procedures. Further investigation such cases may warranted.