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Rahman, N.M., Chapman, S.J., and Davies, R.J. Pleural effusion: a structured approach to care. Br Med Bull. 2004; 72: 31-47.

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Article

Concurrent Occurrence of Chylothorax and Chyloperitoneum in Non-Hodgkin’s Lymphoma

1Department of Internal Medicine, Southern Ohio Medical Center, Portsmouth, U.S.A.


American Journal of Medical Case Reports. 2019, Vol. 7 No. 10, 223-227
DOI: 10.12691/ajmcr-7-10-1
Copyright © 2019 Science and Education Publishing

Cite this paper:
Tariq Sharman, Jeffrey Song. Concurrent Occurrence of Chylothorax and Chyloperitoneum in Non-Hodgkin’s Lymphoma. American Journal of Medical Case Reports. 2019; 7(10):223-227. doi: 10.12691/ajmcr-7-10-1.

Correspondence to: Tariq  Sharman, Department of Internal Medicine, Southern Ohio Medical Center, Portsmouth, U.S.A.. Email: tysharman@yahoo.com

Abstract

Chyle is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids. It is formed in the small intestine during digestion of fatty foods, and taken up by lymph vessels specifically known as lacteals. Chylothorax refers to the presence of lymphatic fluid in the pleural space secondary to leakage from the thoracic duct or one of its main tributaries. Chylothorax is classified as non-traumatic or traumatic. Non-traumatic chylothorax is mainly caused by malignant etiologies accounting for more than 50% of chylothorax diagnoses. Lymphoma is the most common etiology. Chyloperitoneum is the extravasation of milky chyle rich in triglycerides into the peritoneal cavity, which can occur as a result of trauma or obstruction of the lymphatic system. Chylous ascites is an uncommon finding that can be caused by malignancy, cirrhosis and lymphatic disruption after abdominal surgery. The combination of chyloperitoneum and chylothorax is rare. When abdominal lymphatics are obstructed, chylous ascites results and eventually leads to a chylothorax. The Patient is an 82 year old Caucasian male who presented with worsening shortness of breath and abdominal distension. Chest X-ray showed moderate left sided pleural effusion. Bedside ultrasound-guided paracentesis and thoracentesis revealed milky ascetic and pleural fluid respectively. Triglyceride level was 271 mg/dl in the ascetic fluid, and 221 mg/dl in the pleural fluid. Pleural fluid was exudative with lymphocytic predominant cell count and negative cytology. Lymph node biopsy confirmed Non-Hodgkin’s Lymphoma causing the concurrent chylothorax and chyloperitoneum.

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