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• W2894577974 abstract "SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Chylothorax is an infrequent type of pleural effusion caused by obstruction or laceration of the thoracic duct by malignancy, trauma or thoracic surgery.1 These effusions are nearly always exudative. Transudative chylous pleural effusions are extremely rare entity with only few cases reported in the literature to date. We report a case of recurrent transudative chylothorax due to cirrhosis. CASE PRESENTATION: A 63-year-old male with decompensated cirrhosis due to hepatitis C and recurrent right sided pleural effusion presented with progressive shortness of breath and abdominal distention. Physical examination and chest imaging identified large, right sided pleural effusion. Despite being on high doses of diuretics, he required multiple thoracentesis to relieve his symptoms. Gross appearance of the pleural fluid was cloudy pink. Pleural fluid analysis was consistent with transudative chylothorax (triglycerides of 151mg/dl and cholesterol 13mg/dl, total serum protein was 7.1g/dl, pleural fluid protein was 1.3g/dl, serum LDH was 270U/L, pleural fluid LDH was 105U/l). Based on his MELD-Na of 21 and poor responsiveness to medical management including diuretics and multiple therapeutic thoracenteses, patient underwent Transjugular intrahepatic portosystemic shunting (TIPS). Patient had complete resolution of his Pleural effusion following TIPS. DISCUSSION: Chylothorax due to cirrhosis is extremely rare and only accounts for 1% of all cases of chylothorax.2 More common causes are neoplasm, trauma, and thoracic surgery, idiopathic or congenital chylothorax. In decompensated cirrhosis, portal hypertension can lead to increased pressures and lymph flow in the thoracic duct, causing extravasation of chyle into the pleural space. Patient can present with dyspnea, cough, chest pain or hypovolemia. Presence of Chylomicrons or Triglycerides >110 mg/dl in Pleural Effusion is essential in making the diagnosis. Conservative treatment modalities include intermittent thoracentesis, Octreotide administration, Total parenteral nutrition and medium chain triglycerides. Indwelling pleural catheters are contraindicated due to the risk of significant lymphocyte, protein, fat and immunoglobulin loss in the chyle. Patients requiring repeated thoracentesis may benefit from more aggressive interventional approach like Talc Pleurodesis. For high volume chylothorax not responding to Pleurodesis, TIPS can be tried.23 CONCLUSIONS: Transudative chylothorax is associated with Liver cirrhosis. Recognizing this association will prevent unnecessary testing and procedures. Timely diagnosis and early initiation of treatment is pivotal in preventing complications from malnutrition, infection and may be early mortality from septicemia by preventing loss of electrolytes, immunoglobulins and T-lymphocytes. Reference #1: McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respiratory medicine. 2010;104(1):1-8. Reference #2: Bhardwaj H, Bhardwaj B, Awab A. Transudative chylothorax in a patient with liver cirrhosis: A rare association. Heart & Lung: The Journal of Acute and Critical Care. 2015;44(4):363-365. Reference #3: Lutz P, Strunk H, Schild HH, Sauerbruch T. Transjugular intrahepatic portosystemic shunt in refractory chylothorax due to liver cirrhosis. World Journal of Gastroenterology: WJG. 2013;19(7):1140. DISCLOSURES: No relevant relationships by Muhammad Farhan Khaliq, source=Web Response No relevant relationships by Ashish Koirala, source=Web Response No relevant relationships by Hesham Mohamed, source=Web Response" @default.
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• W2894577974 date "2018-10-01" @default.
• W2894577974 modified "2023-09-25" @default.
• W2894577974 title "TRANSUDATIVE CHYLOTHORAX IN A PATIENT WITH LIVER CIRRHOSIS" @default.
• W2894577974 doi "https://doi.org/10.1016/j.chest.2018.08.809" @default.
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