Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion
Chylothorax occurs following dysfunction or disruption of the lymphatic drainage along the thoracic duct. Malignant and traumatic causes account for the majority of these occurrences, with lymphoma accounting for 11-37% of chylothoraces. The clinical course of chylothorax may include dehydration, ma...
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Wiley
2020-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2020/2893942 |
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| author | Chigozirim N. Ekeke Ernest G. Chan James D. Luketich Rajeev Dhupar |
| author_facet | Chigozirim N. Ekeke Ernest G. Chan James D. Luketich Rajeev Dhupar |
| author_sort | Chigozirim N. Ekeke |
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| description | Chylothorax occurs following dysfunction or disruption of the lymphatic drainage along the thoracic duct. Malignant and traumatic causes account for the majority of these occurrences, with lymphoma accounting for 11-37% of chylothoraces. The clinical course of chylothorax may include dehydration, malnutrition, immunosuppression, electrolyte disturbances, infection, and ultimately death. Management of chylothorax is patient-specific and is based on etiology and surgeon experience. Initially, most chyle leaks are managed with nonoperative strategies, such as gut rest, hyperalimentation, and pleural drainage, and, at times, medium-chained fatty acid diet or octreotide, with hopes to decrease chyle production (Zabeck et al. (2011)). High-output chyle leaks following iatrogenic injury or trauma are commonly managed with thoracic duct ligation. Lymphangiography with or without thoracic duct embolization has become increasingly popular and efficacious with the possible benefit of less morbidity (Cope et al. (2002)). We report a case of a 61-year-old male with delayed chylothorax while having an indwelling pleural catheter for malignant pleural effusion during treatment of follicular lymphoma. Percutaneous thoracic duct embolization was attempted but was unsuccessful. Chemotherapy, fluid management, and nutritional support allowed this to resolve over the course of ninety days from diagnosis. We describe the patient’s clinical course and highlight nonoperative management of delayed chylothorax in the setting of follicular lymphoma treatment. |
| format | Article |
| id | doaj-art-c61fcc3fe9614ce68682d2449106610e |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
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| series | Case Reports in Surgery |
| spelling | doaj-art-c61fcc3fe9614ce68682d2449106610e2025-02-03T06:06:44ZengWileyCase Reports in Surgery2090-69002090-69192020-01-01202010.1155/2020/28939422893942Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural EffusionChigozirim N. Ekeke0Ernest G. Chan1James D. Luketich2Rajeev Dhupar3Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USADepartment of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USADepartment of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USADepartment of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USAChylothorax occurs following dysfunction or disruption of the lymphatic drainage along the thoracic duct. Malignant and traumatic causes account for the majority of these occurrences, with lymphoma accounting for 11-37% of chylothoraces. The clinical course of chylothorax may include dehydration, malnutrition, immunosuppression, electrolyte disturbances, infection, and ultimately death. Management of chylothorax is patient-specific and is based on etiology and surgeon experience. Initially, most chyle leaks are managed with nonoperative strategies, such as gut rest, hyperalimentation, and pleural drainage, and, at times, medium-chained fatty acid diet or octreotide, with hopes to decrease chyle production (Zabeck et al. (2011)). High-output chyle leaks following iatrogenic injury or trauma are commonly managed with thoracic duct ligation. Lymphangiography with or without thoracic duct embolization has become increasingly popular and efficacious with the possible benefit of less morbidity (Cope et al. (2002)). We report a case of a 61-year-old male with delayed chylothorax while having an indwelling pleural catheter for malignant pleural effusion during treatment of follicular lymphoma. Percutaneous thoracic duct embolization was attempted but was unsuccessful. Chemotherapy, fluid management, and nutritional support allowed this to resolve over the course of ninety days from diagnosis. We describe the patient’s clinical course and highlight nonoperative management of delayed chylothorax in the setting of follicular lymphoma treatment.http://dx.doi.org/10.1155/2020/2893942 |
| spellingShingle | Chigozirim N. Ekeke Ernest G. Chan James D. Luketich Rajeev Dhupar Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion Case Reports in Surgery |
| title | Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion |
| title_full | Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion |
| title_fullStr | Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion |
| title_full_unstemmed | Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion |
| title_short | Delayed Chylothorax during Treatment of Follicular Lymphoma with a Malignant Pleural Effusion |
| title_sort | delayed chylothorax during treatment of follicular lymphoma with a malignant pleural effusion |
| url | http://dx.doi.org/10.1155/2020/2893942 |
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