CRA59 CHYLOTHORAX SECONDARY TO PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA

Noor Rashidah Abdul Rahman, Nizafaziasyida Fauzee, Megat Razeem Abdul Razak, Aishah Ibrahim
Hospital Tengku Ampuan Afzan, Kuantan

Introduction 

Chylothorax is a rare condition caused by leakage of chyle into the pleural cavity resulting from disruption of the thoracic duct. We report 2 cases of chylothorax secondary to primary mediastinal large B-cell lymphoma which were treated conservatively.

Case reports 

The first case is a 20-year-old female who presented with superior vena cava obstruction with right pleural effusion. Pleural aspiration showed milky-coloured fluid with pleural triglyceride of 2.41mmol/L suggestive of chylothorax. The second case is a 28-year-old male with massive left pleural effusion necessitating chest drainage. His pleural fluid analysis showed pH 7.2, LDH 1989 and glucose 3 mmol/L. Pleural fluid triglyceride levels were measured as the patient continued to drain large amount of cloudy pleural fluid with no signs of infection and positive culture, confirming chylous effusion. In both cases, chest imaging showed a large mediastinal mass, biopsy-proven primary mediastinal large B-cell lymphoma. The chylothorax resolved after treating the lymphoma. 

Discussion 

Chylothorax can occur either spontaneously or as a result of trauma. Malignancies, especially lymphoma are the most common non-traumatic causes of chylothorax. The mechanisms involved in the formation of chyle include direct invasion or external compression of the thoracic duct, as well as rupture of the duct due to infiltration by lymphomatous tissue which alters its structural integrity and makes it prone to rupture. The management of chylothorax involve conservative measures, radiologic intervention or surgery. Both cases were successfully managed conservatively through diet modification, pleural drainage for symptoms relief, and treatment of the underlying disease.