Successful Treatment of Pulmonary Lymphangiectasia in a 6-day-old Neonate

Introduction:

A 6-day-old neonate was transferred from a peripheral hospital to the NICU at Yashoda Hospitals due to respiratory distress and a large pleural effusion. The case presented multiple challenges requiring an advanced multidisciplinary approach. This report highlights the diagnostic journey, treatment strategy, and successful management of the infant.

Case Presentation:

Upon arrival, the neonate exhibited significant respiratory distress. Immediate supportive care was provided, including intercostal drainage. Despite daily drainage of 150-180 ml of lymphocyte-rich pleural fluid, the effusion persisted, necessitating further diagnostic and therapeutic interventions.

Patient History:

A 6-day-old neonate presented with respiratory distress and was referred from a peripheral hospital for further evaluation. Imaging revealed a large pleural effusion, and the baby exhibited persistent accumulation of lymphocyte-rich pleural fluid.

Diagnostic Assessment:

A comprehensive evaluation led to the decision to perform a lymphangiogram. An intranodal lymphangiogram was conducted on the 3 kg infant with both diagnostic and therapeutic purpose. The procedure revealed pulmonary lymphangiectasia as the underlying cause of the lymphatic leak into the pleural cavity.

Treatment Approach:

• Intranodal embolisation with therapeutic lymphangiogram with Lipiodol
• Initiation of a specialized Medium-Chain Triglyceride (MCT) diet
• Administration of octreotide to manage lymphatic leakage
• Continuous monitoring and supportive care in the NICU
• Thoracoscopy was considered; however, it was deemed unnecessary due to the patient’s positive response to above therapy

Outcome:
Despite the challenges during the NICU stay, the neonate showed gradual improvement. The baby responded well to the treatment and was eventually discharged in a stable condition.

Discussion:
Pulmonary Lymphangiectasia is a rare and complex condition, especially in a patient that young. This could be successfully managed because of the well-coordinated multidisciplinary approach of the team consisting of an efficient interventional radiologist for performing lymphangiography with intranodal embolization on this tiny infant and an anaesthesiologist for supporting in this complex case. The case underscores the importance of early diagnosis and targeted treatment in neonatal lymphatic disorders.

Conclusion:
The successful treatment of the neonate was made possible through a collaborative effort from multiple medical teams. The use of an innovative diagnostic approach and targeted therapy led to favourable outcomes, highlighting advancements in neonatal care.