MEDICAL CHYLOTHORAX AN ACUTE FINDING OF AN AGGRESSIVE LYMPHOMA

Abstract

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Chylothorax is a rare complication usually seen in Non-Hodgkin Lymphomas as enlarged mediastinal lymph nodes can compress the thoracic duct. Quick diagnosis is important since the condition can be fatal if left untreated. Persistent loss of chyle could lead to malnutrition, weight loss and immunosuppression. CASE PRESENTATION: Case of a 35y/o man with worsening SOB and fatigue for one month. Associated with night sweats, intermittent dry cough, anorexia, and thoracic back pain. Denied fever, chills, weight loss, emesis or diarrhea. No pertinent past medical but has 4 pack-year smoking history. Findings on physical exam included tachycardia, tachypnea, bilateral inguinal lymphadenopathy, decreased right lung sounds and dullness to percussion. Chest CT detailed an anterior mediastinal mass, right axillary lymph nodes, and a right-sided pleural effusion. The patient was taken to surgery for chest tube placement and inguinal node biopsy. Pleural fluid initially drained serosanguinous fluid which then turned into a milky white fluid. Pleural fluid analysis showed 112mg/dl triglycerides and 48mg/dl cholesterol, suggestive of chylothorax. T-Cell Lymphoblastic Lymphoma was diagnosed. Patient was discharged after chemotherapy and chest tube was removed as chylothorax resolved. DISCUSSION: Diagnosis of chylous pleural effusion is based on the presence of chylomicrons or triglyceride levels >110mg/dl, presence of chylomicrons, low cholesterol level, and elevated lymphocyte count are diagnostic of a chylothorax. In our case, triglycerides were 112mg/dl and cholesterol 48mg/dl in the presence of an aggressive lymphoma. Dietary modifications with low-fat and high-protein diet are suitable for patients with low volume chylothorax. Somatostatin infusions were used as adjuvant therapy as they have been similarly used in the past for reduction of intestinal chyle production and chyle leak. Nevertheless, when managing large chyle leaks, particularly exceeding 1.5 liters per day, early surgical intervention is warranted. CONCLUSIONS: This case highlights the importance of proper recognition and rapid treatment of chylothorax in aggressive lymphomas in order to prevent worsening nutritional status and immunocompetency which may adversely affect prognosis. REFERENCE #1: Khosravi, A., & Anjidani, A. A. (2009). Spontaneous recovery of chylothorax caused by lymphoma. Hematology/Oncology and Stem Cell Therapy, 2(3), 431-434. REFERENCE #2: Kumar, A., Harris, K., Roche, C., & Dhillon, S. S. (2014). A 69-Year-Old Woman with Lymphoma and Chylothorax. Looking Beyond the Usual Suspect. Annals of the American Thoracic Society, 11(9), 1490-1493. REFERENCE #3: Nair, S. K., Petko, M., & Hayward, M. P. (2007). Aetiology and management of chylothorax in adults. European Journal of Cardiothoracic Surgery, 32(2), 362-369. DISCLOSURES: No relevant relationships by Maria Irizarry Zapata, source=Web Response No relevant relationships by Carlos Martinez Crespi, source=Web Response No relevant relationships by Joel Rodriguez Ramos, source=Web Response No relevant relationships by Melissa Vega, source=Web Response No relevant relationships by Lisselle Villarrubia Ocasio, source=Web Response