Spontaneous chylothorax complicating small cell lung cancer – Review of aetiology and diagnosis

Hanina, S.; Vivekananthan, C.; Randhawa, Rabinder; Bhattacharya, Milan; Thomas, P.; Kavidasan, Ajikumar

doi:10.1016/j.rmcr.2015.02.005

Cited by 8 publications

(7 citation statements)

References 6 publications

(19 reference statements)

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“…Ultimately, if left untreated, chylothorax has a 50% mortality rate. 9,11 Light's criteria, Heffner's criteria, and pleural cholesterol levels can be used to classify pleural effusion as exudative or transudative. 12 As per Light's criteria, pleural effusion is considered exudative if it meets at least 1 of the following criteria: 13 -a pleural fluid protein to serum protein ratio >0.5, -a pleural fluid LDH to serum LDH ratio >0.6, or -a pleural fluid total LDH greater than two-thirds the upper limit of normal serum LDH.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax in the Setting of Lung Malignancy

Vangara,

Haroon,

Kalafatis

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Chylothorax refers to chyle within the pleural space, which frequently arises from an interruption in the thoracic duct or because of reduced lymphatic drainage. Pleural fluid that is white/milky in appearance, with a triglyceride concentration of greater than 110 mg/dL, strongly supports the diagnosis of chylothorax. Chylothorax is nearly always exudative. Transudative chylothorax is extremely rare and typically presents due to a secondary cause, such as liver cirrhosis, nephrotic syndrome, or congestive heart failure. We present a case of chylothorax that occurs in the setting of lung adenocarcinoma. A 65-year-old African American man with a past medical history of metastatic right lung adenocarcinoma presented with dyspnea and palpitations. He denied fever, orthopnea, and paroxysmal nocturnal dyspnea. Therapeutic drainage of the left pleural effusion resulted in 650 mL of milky-white fluid. Pleural fluid analysis demonstrated a triglyceride concentration of 520 mg/dL, a pleural/serum protein ratio of 0.41, a pleural/serum lactate dehydrogenase (LDH) ratio of 0.26, a total pleural LDH of 127 IU/L, and a cholesterol level of 58 mg/dL. This effusion can be classified as transudative as per Light’s criteria and exudative as per Heffner’s and pleural cholesterol criteria. A subsequent pleural fluid cytology found malignant cells consistent with lung adenocarcinoma. Malignancy is the most common cause of nontraumatic, exudative chylothorax. Light’s criteria misinterpret about 25% of transudative effusions as exudative. Therefore, to minimize this error, a combination of the 3-criterial consideration is ideal.

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Section: Discussionmentioning

confidence: 99%

Chylothorax in the Setting of Lung Malignancy

Vangara,

Haroon,

Kalafatis

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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“…Data on the association of thrombosis and chylothorax in adults are sparse. In the absence of a clear risk factor for chylothorax (eg, thoracic operation), most associations of chylothorax and vascular thrombosis are with a primary central venous thrombosis that secondarily leads to thoracic duct obstruction and, consequently, chylothorax [7,[17][18][19][20][21][22]. There are only rare case reports from the adult population that describe de novo vascular thrombosis arising after development of the chylothorax.…”

Section: Commentmentioning

confidence: 99%

Chylothorax as a Risk Factor for Thrombosis in Adults: A Proof-of-Concept Study

Hoskote

Yadav

Jagtap

et al. 2018

The Annals of Thoracic Surgery

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“…The diagnosis of chylothorax is di cult as only 50% of the chylothorax cases present with the classic milky appearance of pleural effusion [11]. Delayed diagnosis can result in chronic loss of chyle uid, eventually leading to malnutrition, immunological disorder, and metabolic diseases, even mortality [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

Zhang

Wang

et al. 2023

Preprint

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Background Chylothorax is a condition that can be challenging to diagnose due to its nonspecific clinical presentation. Several biochemical parameters of chylous pleural effusion have been identified as important indicators for the diagnosis of chylothorax. Lymphoscintigraphy, a non-invasive imaging technique, is also used to evaluate chylothorax and determine the location of chyle leakage. This study aimed to evaluate the correlation between the biochemical parameters of chylous pleural effusion and 99mTc-dextran (DX) lymphoscintigraphy in diagnosing chylothorax. Material and methods A total of 120 patients were enrolled, 83 of the patients had unilateral chylothorax, and 37 had bilateral chylothorax. All patients conducted both 99mTc-DX lymphoscintigraphy and pleural effusion laboratory analysis. The images were classified into positive and negative groups based on whether an abnormal accumulation of the radioactive tracer was observed in the thorax on 99mTc-DX lymphoscintigraphy. And the biochemical parameters of the two groups were compared. Results Among these patients, 101 (84.17%) had exudative effusions, and 19 (15.83%) had transudative effusions, according to the levels of pleural effusion protein, lactate dehydrogenase and cholesterol. Abnormal tracer accumulation in thorax was observed in 83 patients (69.17%). Exudative and transudative chylothorax are not associated with lymphoscintigraphy results (P = 0.597). In all biochemical parameters, lymphoscintigraphy positive group had significantly higher levels of pleural effusion triglyceride and pleural effusion triglyceride/serum triglyceride ratio compared with negative group (P = 0.000 and P = 0.005). The cutoff values that we identified for pleural effusion triglycerides and pleural effusion triglyceride/serum triglyceride ratio were 2.870 mmol/L and 4.625, respectively, which can facilitate differentiating the positive and negative results on lymphoscintigraphy. Conclusion Lymphoscintigraphy technique is a reliable diagnostic tool for the qualitative evaluation of chylous pleural effusion. Higher pleural effusion triglyceride level and pleural effusion triglyceride/serum triglyceride ratio indicate a positive result in patients with chylothorax on lymphoscintigraphy, and the cutoff values of 2.870 mmol/L and 4.625 can help with the diagnosis.

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Spontaneous chylothorax complicating small cell lung cancer – Review of aetiology and diagnosis

Cited by 8 publications

References 6 publications

Chylothorax in the Setting of Lung Malignancy

Chylothorax in the Setting of Lung Malignancy

Chylothorax as a Risk Factor for Thrombosis in Adults: A Proof-of-Concept Study

Lymphoscintigraphy findings in patients with chylothorax: influence of biochemical parameters

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