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

Tariq Sharman^1, and Jeffrey Song¹

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

Cite this paper:
Tariq Sharman and 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

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.

Keywords:
chyloperitoneum chylothorax chyle pseudochylothorax chylous ascites lymphoma thoracentesis pleural effusion triglycerides lymphoperitoneal fistula giant lymph node hyperplasia sarcoidosis tuberculosis histoplasmosis yellow nail syndrome systemic lupus erythematosus noonan syndrome nephrotic syndrome

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