Chylothorax and Chylous Ascites Due To Malignant Lymphoma

Abstract

Chyle is a fluid rich in triglycerides and is characterized by the presence of chylomicrons. Chylous effusions are unusual complications of malignant neoplasms, usually lymphomas. The combination of chyloperitoneum and chylothorax is very rare. When abdominal lymphatics are obstructed, chylous ascites results and eventually leads to a chylothorax. We present the case of a 68-year-old woman with a chyloperitoneum and a right-sided chylothorax due to an underlying malignant B-cell lymphoma. After thoracocentesis and replacement therapy with medium chain triglycerides, she was treated with a combination of cyclophosphamide, vincristine and prednisone. This has resulted in a regression of the chylous effusions. A short review of the literature describes causes, diagnosis and therapy of chylous effusions.

Nonspecific Infectious Bilateral Chylothorax and Cyhloabdomen with Symptoms of Acute Abdomen

“…It develops by accumulation of chylous fluid in the pleural cavity and the abdomen, associated with obstruction of the ductus thoracicus or obliteration in one of its branches due to tumoral infiltration, inflammation or trauma [5]. Obstruction in the abdominal lymphatics related to any cause leads to chylous ascites and this condition causes cylothorax [6]. The most common causes of chylothorax are surgery and extra-surgical trauma [2].…”

Peritoneo-venous shunt implantation as a therapy for chylous ascites

“…Chylous flow can be successfully manipulated with starvation and dietary measures, since abdominal lymph flow increases after meals to more than 200 times that of starvation levels (2,7,20,21). Conservative treatment with starvation and parenteral nutrition is therefore successful in some cases, such as after abdominal and retroperitoneal surgery (13,21).…”

Letters to the Editors

“…Other causes include tuberculosis, chronic pancreatitis, cirrhosis, hepatic or portal vein thrombosis, hypothyroidism, mitral stenosis, filariasis, benign tumors, retrosternal goiter, sarcoidosis, angioleiomyomatosis, yellow nail syndrome, hemangiomatosis (Gorham's syndrome), amyloidosis, thrombosis of the superior vena cava or other central veins and heart failure with increased venous pressure. 2,5 The cause of chylous ascitis in the first patient is unknown. The second patient's chyloperitoneum was thought to be due to disruption of lymphatics at the time of abdominal surgery.…”

“…5,7,8 In addition, a fluid with a trigylceride value > 110 mg/dL has a high probability of being chylous. 7 gether worked closely with Professor Constantin I. Parhon, the founder of the Romanian School of Endocrinology and director of the Institute.…”

“…Previous reports pointed out that most cases have a poor prognosis because preoperative diagnosis at an early stage is difficult. [1][2][3][4][5] A 70-year-old woman, gravida 2, was not on hormone replacement therapy. She had atypical vaginal bleeding and underwent cytologic examination …”