Keywords
Pleural effusion
Chylothorax
Chemotherapy
Radiotherapy
How to Cite
Abstract
Chylothorax is a medical condition characterized by the accumulation of chyle within the pleural cavity. Chyle is a milky fluid composed of lymph and emulsified fats that is normally transported through the lymphatic system. Chylothorax occurs when there is disruption or damage to the thoracic duct or other lymphatic vessels, causing chyle to leak into the pleural space. The most common causes of chylothorax include lymphomas, followed by bronchogenic carcinoma and trauma. Diagnosis is obtained by thoracentesis and determination of triglyceride and cholesterol concentrations in pleural fluid. We report 2 clinical cases of patients diagnosed with diffuse large B-cell lymphoma post-germinal center phenotype and mantle cell lymphoma, who received treatment with chemotherapy protocol R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone). During oncological follow-up they presented pleural effusion as a complication. In both cases the pleural effusion was drained and biochemical tests of the pleural fluid confirmed the diagnosis of chylothorax. In both cases the patients improved with parenteral nutrition and chemotherapy, without requiring surgical procedures or interventions by interventional radiology.
References
Admire K, Cirino-Marcano M. Chylothorax as the Initial Manifestation of Follicular Lymphoma. Ann Intern Med Clin Cases. 2023;2(6):e220790.
Krūmiņa A, Auziņa D, Legzdiņa A, Lejniece S. Chylothorax: A Tangled Road to Definitive Diagnosis of Non-Hodgkin Lymphoma. Am J Case Rep [Internet]. 8 de junio de 2023 [citado 30 de noviembre de 2023];24. Disponible en: https://www.amjcaserep.com/abstract/index/idArt/939098
Cholet C, Delalandre C, Monnier-Cholley L, Le Pimpec- Barthes F, El Mouhadi S, Arrivé L. Nontraumatic Chylothorax: Nonenhanced MR Lymphography. RadioGraphics. 2020;40(6):1554-73.
Riley LE, Ataya A. Clinical approach and review of causes of a chylothorax. Respir Med. 2019;157:7-13.
Skouras V, Kalomenidis I. Chylothorax: diagnostic approach: Curr Opin Pulm Med. 2010;16(4):387-93.
Ur Rehman K, Sivakumar P. Non-traumatic chylothorax: diagnostic and therapeutic strategies. Breathe. 2022;18(2):210163.
Mas IB. Análisis de una serie médica de quilotórax y pseudoquilotórax en el H.U. San Juan de Alicante: estudio de 25 años.
Barillas S, Rodas A, Ardebol J, Martí JL. Nontraumatic chylothorax secondary to lymphoma and filariasis. J Surg Case Rep. 2020;2020(9):rjaa309.
Villena V, De Pablo A, Martin-Escribano P. Chylothorax and chylous ascites due to heart failure. Eur Respir J. 1995;8(7):1235-6.
Romero S, Martin C, Hernandez L, Verdu J, Trigo C, Perez-Mateo M, et al. Chylothorax in Cirrhosis of the Liver. Chest. 1998;114(1):154-9.
Lin WY, Lin GM, Wu CC. Coexistence of non-communicated chylothorax and chylous ascites in nephrotic syndrome. Nephrol Carlton Vic. 2009;14:700.
Nadolski G. Nontraumatic Chylothorax: Diagnostic Algorithm and Treatment Options. Tech Vasc Interv Radiol. 2016;19(4):286-90.
Janjetovic S, Janning M, Daukeva L, Bokemeyer C, Fiedler W. Chylothorax in a Patient with Hodgkin’s Lymphoma: A Case Report and Review of the Literature. Tumori J. 2013;99(3):e96-9.
O’Callaghan AM, Mead GM. Chylothorax in lymphoma: Mechanisms and management. Ann Oncol. 1995;6(6):603-7.
Braun CM, Ryu JH. Chylothorax and Pseudochylothorax. Clin Chest Med. 2021;42(4):667-75.
Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc. 1980;55(11):700-4.
Gibbons SM, Ahmed F. Chylothorax diagnosis: can the clinical chemistry laboratory do more? Ann Clin Biochem. 2015;52(1):173-6.
McGrath EE, Blades Z, Anderson PB. Chylothorax: Aetiology, diagnosis and therapeutic options. Respir Med. 2010;104(1):1-8.
Sriram K, Meguid RA, Meguid MM. Nutritional support in adults with chyle leaks. Nutrition. 2016;32(2):281-6.
Kalomenidis I. Octreotide and chylothorax: Curr Opin Pulm Med. 2006;12(4):264-7.
Esme H. The use of octreotide in the treatment of chylothorax. J Contemp Med. 31 de 2019;9(4):432-5.
Pospiskova J, Smolej L, Belada D, Simkovic M, Motyckova M, Sykorova A, et al. Experiences in the treatment of refractory chylothorax associated with lymphoproliferative disorders. Orphanet J Rare Dis. 2019;14(1):9.
Sahin F. A case of chylothorax due to diffuse large B-Cell lymphoma. Integr Cancer Sci Ther [Internet]. 2021 [citado 27 de noviembre de 2023];8(3). Disponible en: https://www.oatext.com/a-case-of-chylothorax-due-to-diffuse-large-b-cell-lymphoma.php
Paul S, Altorki N, Port J, Stiles B, Lee P. Surgical Management of Chylothorax. Thorac Cardiovasc Surg. 2009;57(04):226-8.
All material published in the journal HEMATOLOGÍA (electronic and print version) is transferred to the Argentinean Society of Hematology. In accordance with the copyright Act (Act 11 723), a copyright transfer form will be sent to the authors of approved works, which has to be signed by all the authors before its publication. Authors should keep a copy of the original since the journal is not responsible for damages or losses of the material that was submitted. Authors should send an electronic version to the email: revista@sah.org.ar