Massive milky pleural effusion.
نویسندگان
چکیده
To cite: Aju R, Chaubey VK. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-203105 DESCRIPTION A 53-year-old man with a history of non-Hodgkin’s lymphoma (NHL) presented with worsening shortness of breath. He was diagnosed with bulky grade III follicular lymphoma 5 years ago and was in remission after receiving eight cycles of chemotherapy. The chest X-ray revealed a left-sided pleural effusion (figure 1A). During thoracentesis, chylousappearing fluid was removed (figure 1B). The pleural fluid had chylomicrons, and a high triglyceride level confirmed the presence of a chylothorax. Computed axial tomography of the chest unveiled a large soft tissue mass surrounding the descending thoracic aorta as well as multiple mediastinal lymph nodes, leading to concerns about the recurrence of lymphoma (figure 1C,D). The patient underwent video-assisted thoracic surgery, and a lymph node biopsy showed follicular lymphoma. Small-tomedium sized lymphoid cells with irregular nuclear membranes are seen on H&E stain of the lymphoid mass (figure 1E). Immunohistochemistry showed expression of CD10, CD20, CD23 and B-cell lymphoma-2 consistent with B-cell follicular lymphoma (figure 1F). The bone marrow biopsy was normal. The patient continued to have reaccumulation of massive amounts of chylous fluid, requiring multiple thoracentesis. Thoracic duct ligation was considered, but it was technically difficult in our patient, as the mass was encasing the thoracic duct. The patient was started on a medium chain triglyceride diet. Chemotherapy was initiated. Chylothorax is an uncommon and poorly described complication of NHL remission from NHL. Our case emphasises the presence of recurrent chylothorax in NHL and challenges in management.
منابع مشابه
Chylous pleural effusion: A rare presentation of Non-Hodgkin- Lymphoma
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عنوان ژورنال:
- BMJ case reports
دوره 2014 شماره
صفحات -
تاریخ انتشار 2014