Complete Resolution Of Pleural Effusion Research Articles

Medical management of idiopathic chylothorax in a crossbreed cat with octreotide and rutin use: A case report

BThis case report describes the diagnosis and treatment of idiopathic chylothorax in a 5-year-old female crossbreed cat who presented with respiratory distress, tachypnea, cyanosis, exercise intolerance and weight loss over a short period of time. Based on the clinical examination, blood results, radiological and echocardiographic findings, the patient was diagnosed with chylous effusion. Chylothorax was considered idiopathic because there was no underlying trauma or disease etiology. Effusion drainage was performed by thoracocentesis to reduce respiratory stress. After thoracocentesis, followed by using medical octreotide- a somatostatin analogue (Sandostatin™, 0.1 mg/ml ampoule, Novartis, USA) and rutin - a flavone benzo-γ-pyrone plant fruit extracted from the Brazilian plant Fava D'anta (Dimorphandra mollis) (Rutin - Plant-Based Bioflavonoid, 500 mg tablet, Solgar™, USA), were administered in addition to supportive treatment. Rutin and ocreotide have been used successfully in humans, dogs and cats to the treatment of pleural effusions as presented various studies. It is hoped that these drugs may also be useful for decreasing pleural effusion in cats with chylothorax. In this represented case; partial resolution of pleural effusion was observed after octreotide usage and complete resolution of pleural effusion was observed after rutin (plant-based bioflavonoid) usage. No recurrence was observed during 7 months of regular follow-up.It was determined that the use of octreotide and rutin after thoracocentesis gave successful results in the medical management of idiopathic chylothorax in cats.

Prospective evaluation of lymphatic embolization as part of the treatment in dogs with presumptive idiopathic chylothorax.

To describe the embolization technique and short-term clinical outcome in dogs undergoing lymphatic embolization (LE) as part of treatment for presumptive idiopathic chylothorax (IC). Additionally, to document findings in computed tomography lymphangiography (CTLa) following embolization. Prospective case series. Eight client-owned dogs. Dogs underwent CTLa followed by thoracic duct ligation (TDL), pericardiectomy (PC) and LE. A mixture of 3:1 lipiodol: n-butyl cyanoacrylate embolic solution was injected through a catheterized mesenteric lymphatic vessel via limited abdominal approach using intraoperative fluoroscopy. CTLa was scheduled for 12 weeks postoperatively, and long-term follow-up was obtained via telephone contact. LE was technically successful in six of the eight dogs; and clinically successful in five of the six dogs. In the unsuccessful dog, a diagnosis of lymphangiosarcoma was determined, and the owners elected for euthanasia. Five dogs who underwent successful LE underwent CTLa at 12 weeks. Complete resolution of pleural effusion occurred in three dogs and scant pleural effusion in two dogs. A robust lymphatic embolus preventing antegrade continuation of radiocontrast was documented in all five dogs. Five of the six dogs that underwent LE, were alive and clinically normal at 358-960 days postoperatively. LE is a feasible part of treatment for dogs with IC. Additionally, a robust lymphatic embolus and lack of radiocontrast flow past the embolus was documented at 12 weeks following surgery. LE has the potential to reduce surgical failure by reducing efferent lymphatic chyle flow, occluding missed lymphatic branches and preventing the development of collateral branches.

A CASE OF SARCOIDOSIS-RELATED CHYLOTHORAX SECONDARY TO LYMPHANGIECTASIA

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Chylothorax is a rare complication of sarcoidosis with few cases reported in literature. The mechanism is unclear. but some have speculated that the etiology is thoracic duct obstruction due to mediastinal lymphadenopathy. (1) To our knowledge, this is the first reported case of sarcoidosis-related chylothorax secondary to lymphangiectasia without evidence of lymphadenopathy or thoracic duct obstruction. CASE PRESENTATION: D.O is a 47-year-old female with history of stage IV sarcoidosis and chronic diarrhea for 2 years who presented with intermittent chest pain, shortness of breath and anasarca for 2 weeks. Vital signs were normal. Physical exam revealed bibasilar lung crackles with diminished breath sounds and 3+ bilateral lower extremity edema. CBC, hepatorenal function, Urinalysis, troponin, EKG were normal. Albumin was 1.7g/dL and alpha-1 antitrypsin was positive in stool. CT scan of the chest and abdomen revealed bilateral pleural effusion (R>L), pericardial effusion and 3rd spacing of fluid within mesentery and subcutaneous tissues. No lymphadenopathy was demonstrated. Echocardiogram was normal. Thoracentesis revealed milky fluid. Pleural fluid/Serum LDH < 0.6 and pleural fluid/serum protein < 0.5 indicating transudate as per light’s criteria. Triglycerides were 97mg/dL and chylomicrons were present. EGD with duodenal biopsies and colonoscopy with ileal biopsies revealed wide lamina propria with dilated lacteals in the small bowel mucosa consistent with the diagnosis of lymphangiectasia. No granulomas were identified. Stains for AFB, fungi and T.whipplei were negative. It was concluded that the patient had developed chylothorax and protein-losing enteropathy secondary to lymphangiectasia. Patient was advised lifelong dietary modification incorporating medium chain triglycerides and avoiding long chain triglycerides. Steroids were not initiated. Significant clinical improvement was noted at follow up after 3 months and chest x-ray showed complete resolution of pleural effusion. DISCUSSION: Classically, chylothorax is unilateral, exudative, milky white pleural effusion. Bilateral transudative chylothorax is uncommon. (2) In this case, we suspect the transudative quality was secondary to protein-losing enteropathy. Management with dietary modifications, octreotide, antiplasmin, steroids and surgical intervention have been discussed in literature. (3) In our patient, clinical improvement was achieved with dietary modifications alone. CONCLUSIONS: In rare diseases, diagnosis often requires a multidisciplinary approach. In this case, colonoscopy was initially planned due to suspicion for intestinal sarcoidosis and even though discovery of chylothorax pushed lymphangiectasia higher up in the differential, chylothorax secondary to sarcoidosis was still the top differential until histopathology was reported. When clinical suspicion is high, lymphoscintigraphy can aid in a quicker diagnosis. Reference #1: Bhattaria B, Schmidt F, Devkota A et al. A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication. J Community Hosp Intern Med Perspect. 2015; 5(4). Reference #2: Diaz-Guzman E, Culver DA, Stoller JK. Transudative Chylothorax: Report of Two Cases and Review of the Literature, Lung. 2005 May-Jun;183(3):169-75. Reference #3: Alshikho MJ, Talas JM, Noureldine SI et al. Intestinal Lymphangiectasia: Insights on Management and Literature Review. AM J Case Rep. 2016; 17: 512–522. DISCLOSURES: No relevant relationships by Rama El-Yafawi, source=Web Response No relevant relationships by Azib Shahid, source=Web Response

Insolit pancreatic-pleural fistula after surgery

Background: Pleural effusion secondary to pancreatic-pleural fistula (PPF) is a rare entity. Its main cause is acute or chronic pancreatitis and its diagnosis is difficult and can be confirmed by toracocentesis. Our aim is to show the case of a patient who presented a recurrent pleural effusion due to a PPF after surgery. Material & Methods: A 26-year-old male with no relevant medical history was diagnosed of malignant mesenchymal neoplasia located in the upper pole of the left kidney measuring approximately 9.5x 8.7x1.6cm. The patient underwent resection of the left kidney and suprarenal, spleen, body and tail of the pancreas, left tail and diaphragmatic patch. He presented initial postoperative without incidents until the sixth day when he began with respiratory distress and abdominal distension. A CT scan was performed reporting a severe left pleural effusion. Thoracic drainage showed high amylase compatible with pancreatic fistula in liquid. Results: According to the literature, the initial treatment in our patient was non-operative using total parenteral nutrition and thoracic drainage. We started an anti-secretory octreotide and antibiotic therapy. The evolution was satisfactory, so we decide not to manage endoscopically with ERCP to place of a stent as we could see in cases of PPF due to pancreatitis. The patient presented a satisfactory evolution and he was discharged at home 4 days after complete resolution of pleural effusion. The definitive AP was high-grade undifferentiated pleomorphic sarcoma. Follow-up at 7 months showed the patient is well. Conclusions: PPF is an uncommon complication, which has been described in the majority of cases in patients with pancreatitis. We want to point out the importance of surgery as a risk factor in this entity so we should consider this diagnosis in patients with thoracic complaints and a history of earlier pancreatic surgery.

CHEST WALL MASS IN A PATIENT WITH RECURRENT PLEURAL EFFUSION

SESSION TITLE: Chest Infections 4 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Recurrent exudative pleural effusion often presents a diagnostic challenge. Undetected malignancy and indolent infections should be considered in the differential. We present one such case. CASE PRESENTATION: A 62 year old Caucasian male with severe COPD (FEV1 1.54 L or 49% predicted) presents for evaluation of dyspnea and productive cough. Further history is notable for 44 pack year smoking, cats at home, poor dental hygiene, and occupation as a truck driver.CXR is positive for left pleural effusion, with CT demonstrating moderate non-loculated pleural effusion. Thoracentesis reveals exudative fluid, negative cytology, stains, and culture including AFB/ fungal.At eight months follow up, he presents with a palpable, firm, left posterior chest wall mass. MRI demonstrates the palpable mass to be a lipoma. MRI also reveals an invasive 9x7x3 cm pleural based tissue mass in the left costophrenic sulcus infiltrating through the pleural space into the posterior chest wall. Chest CT done next day confirms large left sided pleural effusion with lingular and left lower lobe atelectasis. An irregular mass showing some central low density attenuation in the left paraspinous area measuring 33 x 40 mm was detected. PET/CT reveals large lobulated intense uptake abnormality in the same area with SUV of 8.7. Differential diagnoses included mesothelioma, pleural metastasis, and soft tissue sarcoma.Additional workup included CT guided needle aspiration and core biopsy of the lesion. Aspirate reveals acute and prominent histiocytic inflammation. Core biopsy demonstrates conspicuous sulfur granules displaying prominent Splendore-Hoeppli phenomenon. Tissue gram stain reveals numerous thin beaded, branching filamentous bacteria within these sulfur granules.He underwent thoracotomy with decortication and left pleurectomy. Loculated fluid collection demonstrated benign cytology with colonies of Gram positive and GMS positive filamentous bacteria morphologically consistent with Actinomycosis. No readily identifiable communication tract was found between the chest and the chest wall abscess.He was treated with penicillin for protracted period with CT chest showing complete resolution of pleural effusion 16 months later. DISCUSSION: This case highlights the fact that in cases of recurrent exudative pleural effusion in a setting of poor dental hygiene and COPD, Actinomycosis should be in the differential diagnosis. Penicillins remain the mainstay for treatment with protracted course needed for complete resolution. CONCLUSIONS: Indolent infections should be considered in the differential diagnosis of recurrent pleural effusion. Cutaneous masses/lump in the chest wall in association with pleural effusion should raise suspicion of Actinomycosis/Empyema necessitans. Reference #1: Choi H, Lee H, Jeong SH, Um S-W, Kown OJ, Kim H. Pulmonary actinomycosis mimicking lung cancer on positron emission tomography. Annals of Thoracic Medicine. 2017;12(2):121-124. https://doi.org/10.4103/1817-1737.203752. DISCLOSURES: No relevant relationships by Riju Dasgupta, source=Web Response No relevant relationships by Asok Dasgupta, source=Web Response No relevant relationships by Paresh Timbadia, source=Web Response No relevant relationships by James Uhlenbrock, source=Web Response

Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature.

Myeloid sarcoma is an extramedullary tumor seen most commonly in patients with acute myeloid leukemia and less frequently in chronic myeloid leukemia, myelodysplastic syndrome and rarely, in an isolated form without any other underlying malignancy. Malignant pleural effusion in hematological malignancies is rare when compared with solid tumors. We present an unusual case of myeloid sarcoma in which a mediastinal mass with pleural effusion was the initial presentation. A 27year old gentleman presented with complaints of fever, chest pain and swelling in the anterior chest wall for 6months. Examination revealed a lump measuring 5×5cm on the left side of the chest wall. Hematological evaluation showed hemoglobin-14.2g/dL, platelet count-233×10(9)/L, TLC-117×10(6)/L with normal differential counts. Contrast enhanced computerised tomography (CECT) confirmed the presence of a soft tissue mass in the superior mediastinum abutting against the chest wall. Core biopsy was suggestive of myeloid sarcoma and immunohistochemistry was positive for myeloperoxidase and negative for CD3, CD 20 and CD 23. Pleural fluid analysis showed the presence of malignant cells. Bone marrow examination did not show an excess of blasts. A final diagnosis of extramedullary myeloid sarcoma with malignant pleural effusion was made. The patient was given induction chemotherapy (3+7 regimen) with daunorubicin and cytosine arabinoside. Repeat CECT done on day 28 showed complete resolution of pleural effusion and significant reduction in the size of mediastinal mass. The patient has successfully completed three cycles of consolidation therapy following which there has been complete resolution of the mass. He remains asymptomatic on close follow up.

Long-Term Assessment of Dasatinib-Induced Pulmonary Arterial Hypertension in Chronic Myeloid Leukemia

▪Background: To explore a real incidence of dasatinib-induced pulmonary arterial hypertension (D-PAH) in clinical practice, we investigated 82 imatinib or other 2G tyrosine kinase inhibitor (TKI)-failed chronic myeloid leukemia (CML) patients who received dasatinib as a second-line therapy.Methods: Routine chest X-ray and Doppler echocardiography were regularly evaluated in all patients and additional tests were performed if dyspnea developed on treatment.Results: Median age at the time of starting dasatinib was 48 (16-82) years. Of 82 patients, 8 patients (9.8%) showed an elevation of right ventricular systolic pressure (RVSP>35mmHg) by Doppler echocardiography. Among them, 7 patients (8.5%) were considered D-PAH with a median dasatinib treatment duration of 32.6 (10.3-108.7) months. They underwent follow-up Doppler echocardiography median 5 (2-9) times.Five patients showed severe D-PAH (RVSP >70mmHg), 1 was moderate (RVSP 46mmHg), and 1 was mild (RVSP 41mmHg). Advanced studies such as pulmonary angiographic catheterization (patient 1 and 2) or pulmonary arterial computed tomography (patient 3 and 4) were performed for confirming D-PAH or ruling out PAH due to pulmonary vascular abnormality. Six patients had bilateral pleural effusion and 1 had unilateral pleural effusion. With sildenafil (n=5) + dose reduction (n=1) + switch to other TKI (n=6), all of patients improved dyspnea, and RVSP level was completely resolved in 3 patients. In addition, previous nilotinib therapy and concomitant pleural effusion were significant contributing factors for D-PAH.Conclusion: Regardless of complete resolution of pleural effusion, a patient with sustained dyspnea on dasatinib treatment should be carefully evaluated by Doppler echocardiography and a regular monitoring will be needed for early intervention.Abstract 5535. Table 1Characteristics of patients with dasatinib-induced PAHCohortAge at PAH diagnosis (year)SexTreatment duration before dasatinib (month)Previous therapy for CMLDuration between initiation of dasatinib and diagnosis of PAH (month)Daily mean dose of dasatinib (mg/d)Duration between diagnosis of D-PAH and last follow up (month)Treatment of D-PAHSwitch to other TKIOutcome153M54.4Interferon, Hydroxyurea, Imatinib, nilotinib26.412373.5Sildenafilnilotinib and ponatinibpartial250M36.6Interferon, Hydroxyurea, Imatinib, dasatinib, nilotinib50.311255.2Sildenafilnilotinib and radotinibpartial337F31.7Imatinib, nilotinib21.78839.7SildenafilDose de-escalationradotinibpartial445M70.9Hydroxyurea, Imatinib69.810135.2SildenafilDose de-escalationponatinibcomplete559F107.4Interferon, Hydroxyurea, Imatinib83.69214.3noneradotinibpartial646F12.6Imatinib29.17613.0Steroid, Sildenafilradotinibcomplete738F30.2Imatinib33.19810.2Dose reductionNAcomplete DisclosuresNo relevant conflicts of interest to declare.

Minimally invasive treatment of idiopathic chylothorax in dogs by thoracoscopic thoracic duct ligation and subphrenic pericardiectomy: 6 cases (2007–2010)

To describe a technique and evaluate the outcome of thoracoscopic thoracic duct ligation (TDL) and subphrenic pericardiectomy (SPP) for treatment of idiopathic chylothorax (IC) in dogs. Retrospective case series. 6 client-owned dogs. Medical records of dogs with a diagnosis of IC that were subsequently treated by thoracoscopic TDL and SPP and that had not undergone previous surgical treatment were reviewed. Thoracoscopic TDL was performed via a 3-portal technique with the patient in lateral recumbency. Subphrenic pericardiectomy was subsequently performed via a 3-portal technique with the patient in dorsal recumbency. If visualization during SPP was suboptimal, 1-lung ventilation was used to ensure that pericardial resection was close to the phrenic nerves bilaterally but without risk of iatrogenic nerve injury. All TDL and SPP procedures were completed successfully in a median surgical time of 177 minutes (range, 135 to 210 minutes). All 6 dogs showed resolution of clinical signs of chylothorax with no recurrence during a median follow-up period of 39 months (range, 19 to 60 months). Final postoperative thoracic radiographic evaluation was performed at a median of 14.5 months (range, 7 to 25 months). Complete resolution of pleural effusion occurred in all but 1 dog. In 1 dog, a small volume of pleural effusion was persistent at a 7-month postoperative radiographic follow-up but was not associated with clinical signs and did not require thoracocentesis at any time during the dog's 25-month follow-up period. From this limited series of patients, results suggested that a minimally invasive TDL-SPP combined surgical technique for management of IC in dogs may be associated with a similarly successful outcome as has been reported for open surgical TDL-SPP.

Kimura Disease

Kimura disease is a rare, benign, chronic inflammatory condition of unknown etiology. Histopathologically, it is manifested by an abnormal proliferation of lymphoid follicles and vascular endothelium, and clinically the disorder involves the skin, lymph nodes, and salivary glands. Kimura disease is usually seen in young adults during the third decade of life. Patients typically present with a solitary enlarged lymph node or generalized lymphadenopathy. We report a case of a 60-year-old nondiabetic, normotensive man who presented with complaints of low-grade fever and dry cough of 6 months duration. He had multiple firm, discrete, painless, enlarged cervical lymph nodes. Chest radiography revealed a right pleural effusion. A complete blood count showed an increased absolute eosinophil count. Pleural fluid examination revealed an eosinophillic exudate. Pleural biopsy was negative for granulomatous inflammation or malignant disease. Lymph node biopsy showed congested blood vessels with moderate eosinophilic infiltration of the cortex of the lymph node consistent with Kimura disease. No follicular hyperplasia or granulomas were seen. Oral prednisolone therapy was initiated and the patient showed gradual improvement in symptoms and complete resolution of pleural effusion.

KIT Inhibitor Midostaurin Exhibits a High Rate of Clinically Meaningful and Durable Responses in Advanced Systemic Mastocytosis: Report of a Fully Accrued Phase II Trial

AbstractAbstract 316 Background:The pathogenetic and high frequency D816V KIT mutation in aggressive systemic mastocytosis (ASM) and mast cell leukemia (MCL) exhibits in vitro and clinical resistance to imatinib. Midostaurin (PKC412) is an inhibitor of the KIT tyrosine kinase and can block D816V KIT-transformed cell growth at an IC50 of 30–40nM. Herein we report updated results of our fully accrued investigator-initiated, multicenter, phase II study of oral PKC412 in World Health Organization-defined ASM/MCL patients (pts). Method:PKC412 100 mg bid was administered as continuous 28-day cycles until progression/ intolerable toxicity. Lack of a major response (MR) or partial response (PR) per Valent criteria by the end of 2 cycles resulted in discontinuation from the protocol. Result:Efficacy and safety data for all 26 pts (15 male: 11 female) are presented. The distribution of SM pts with one or more “C” findings included ASM (n=4), SM-CMML (n=14), SM-MDS (n=3), SM-MDS/MPN-U (n=1), and MCL (n=4, two with associated MDS). The median age of pts was 62 years (range 24–79 years), and the median # of prior therapies was 1.5 (range 0–4). Responses have been observed in 18/26 pts (69%), consisting of 10 pts (38%) with a MR (6 incomplete remissions and 4 pure clinical responses), 5 pts (19%) with a good partial response (GPR), and 3 pts with a minor PR . Four pts had stable disease, and 4 pts exhibited progressive disease (PD). In subjects with higher quality responses, responses have been durable, with PKC412 administered for a median of 19.5 cycles (1.5 years) for MR pts and 15 cycles (1.2 years) for MR+PR pts (range 4+ - 58+ cycles). Major responses have included normalization of hypoalbuminemia, improvement of hemoglobin and platelet counts, and resolution of liver function abnormalities. High quality responses have also included near complete resolution of pleural effusion and ascites (with reduction of paracentesis), and substantial reversion or normalization of weight loss (including one pt discontinuing TPN). Clinically meaningful responses have been accompanied by reduction of palpable and/or 3-D volumetric CT measurement of hepato/splenomegaly, a >50% decrease in the serum tryptase level and/or marrow mast cell (MC) burden, and improvement in mediator symptoms and ECOG performance status. Cutaneous mast cell lesions faded in 2 pts. One patient with MCL has achieved a near complete remission with RBC transfusion independence, normalization of albumin, disappearance of 18 cm palpable splenomegaly (70% volume reduction by imaging), decrease of serum tryptase from 763 to < 20 ng/mL, and decrease of marrow MC burden from 60–70% to 5%. Of particular interest, in 3 pts with SM-CMML (all D816V KIT+), associated marked eosinophilia normalized (e.g. decreased from 50% to 1% in one pt).The most common grade 1–2 non-hematologic toxicities were nausea and/or vomiting, and less frequently diarrhea and fatigue. Asymptomatic and reversible hyperlipasemia occurred in 5 pts (grade 3, n=1). Hematologic toxicity with a suspected relationship to PKC412 has included ≥ grade 3 worsening of pre-existing anemia, and in one pt, recurrent grade 3 thrombocytopenia despite dose reduction to 50 mg bid. Dose reduction was undertaken in 4 additional pts (N/V, n=2; HA, n=1; transient increase in pre-existing pleural effusion, n=1). Dose re-escalation to 100 mg bid was feasible in 3 of these 4 pts. As of August 5, 2010, 8 pts continue PKC412, and treatment has been discontinued in 18 pts. Among the latter, 2 pts had PKC412 discontinued after 4 cycles (grade 3 fatigue, grade 2 N/V, n=1 each), and 7 initial responders have terminated therapy for PD after 8–39 cycles (1 for progression of CMML). Allele-specific PCR detected D816V KIT in 18/26 (69%) pts, and a novel, activating two–amino acid insertion in MPL was identified in a D816V KIT-negative pt. A statistically significant association was observed between positivity for D816V KIT and achieving a MR versus any other type of response (p=0.0095, Fisher's exact test). Pharmacokinetic data and histopathologic correlates of response (e.g. marrow MC burden and serum tryptase levels) will be presented. Conclusion:PKC412 is well tolerated and exhibits clinically relevant and durable responses which compare very favorably to literature reports of interferon-alpha or cladribine in advanced SM. An ongoing international trial aims to further evaluate the efficacy and safety of PKC412 in this pt population. Disclosures:Gotlib:Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding. George:Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dutreix:Novartis: Employment. Gross:Novartis: Employment. Nikolova:Novartis: Employment. Graubert:Novartis: Research Funding.

Evaluation of mesenteric lymphangiography and thoracic duct ligation in cats with chylothorax: 19 cases (1987–1992)

Summary Mesenteric lymphangiography and thoracic duct ligation were performed on 19 cats with chylothorax between 1987 to 1992. Chylothorax was diagnosed on the basis of detection of chylomicrons in the pleural effusion or determination of a cholesterol concentration:triglyceride concentration ratio of &lt; 1 in the pleural fluid. Preoperative medical treatment consisted of thoracentesis (19 of 19 cats) and feeding a fat-restricted diet (14 of 19 cats). Positive-contrast mesenteric lymphangiography was performed before thoracic duct ligation to identify an underlying cause for the effusion. Lymphangiectasia was diagnosed by use of radiography in 17 cats, none of which had evidence of a thoracic duct rupture. Thoracic duct ligation was performed via an incision made through the left 10th intercostal space. Lymphangiography was repeated immediately after ligation of the thoracic duct to document occlusion of all branches. Follow-up monitoring was done for 12 to 47 months (median, 28 months) and consisted of physical examination, evaluation for clinical signs related to pleural effusion, and thoracic radiography. Ten of 19 (53%) cats had complete resolution of pleural effusion. Nonchylous effusion, localized in the right hemithorax, was detected in 1 cat 2 months after thoracic duct ligation, but resolved after thoracotomy, breakdown of thoracic adhesions, and expansion of the right cranial lung lobe. Chylous effusion resolved 3 to 7 days (mean, 5.4 days) after surgery in the 10 cats that survived &gt; 12 months after surgery. Four cats died between 2 and 13 days after thoracic duct ligation, but pleural effusion had resolved in 3 of these 4 cats at the time of death. Five cats were euthanatized 8 to 36 days after surgery because of persistent chylous effusion after thoracic duct ligation.