Abstract
Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in the leakage of chyle into the pleural space. A number of interventions have been used to treat chylothorax including the treatment of the underlying disease. Lymphoma is found in 70% of cases with nontraumatic malignant aetiology. Although patients usually have advanced lymphoma, supradiaphragmatic disease is not always present. We discuss the case of a 63-year-old woman presenting with progressive respiratory symptoms due to chylothorax. She was diagnosed with a stage IIE retroperitoneal grade 1 follicular lymphoma extending from the coeliac trunk towards the pelvic inlet. Despite thoracocentesis and medium-chain triglycerides (MCT), diet chylothorax reoccurred. After low dose radiotherapy (2 × 2 Gy) to the abdominal lymphoma there was a marked decrease in lymphadenopathy at the coeliac trunk and a complete regression of the pleural fluid. In this case, radiotherapy was shown to be an effective nontoxic treatment option for lymphoma-associated chylothorax with long-term remission of pleural effusion.
Highlights
Chylothorax is a rare cause of a large pleural effusion and progressive respiratory failure
To our knowledge, the first case report of a 63-year-old patient presenting with right-sided chylothorax caused by a concomitantly diagnosed follicular lymphoma and successfully treated with low dose radiotherapy (2 × 2 Gy)
A large number of novel agents are in the clinical pipeline for treatment of follicular lymphoma but radiotherapy remains a good remedy to extend the duration of remission without adding any further burden of toxicity [18, 20, 29,30,31]
Summary
Chylothorax is a rare cause of a large pleural effusion and progressive respiratory failure. Increased pressure in the thoracic duct may cause retrograde flow of chyle via the lymphatics of the parietal pleura into the pleural cavity. Another mechanism is thoracic duct rupture due to infiltration of the duct by a lymphoma which causes the susceptibility of the duct to rupture [12]. Given the potential longterm survival of these patients, treatment with favourable side-effect profile and minimal long-term risks is desired [20] To our knowledge, this is the first case report in which low dose radiotherapy was planned as primary treatment to obtain a complete remission of the pleural effusion
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