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• W2980451754 abstract "SESSION TITLE: Disorders of the Pleura SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/21/2019 3:15 PM - 4:15 PM INTRODUCTION: Chylothorax is a collection of chylous fluid in the pleural space that frequently arises from an interruption in the thoracic duct. The fluid is commonly exudative with a high lactate dehydrogenase and elevated triglyerides and chylomicrons. Transudative chylothoraces are less common and typically present due to a secondary cause, including congestive heart failure or cirrhosis. We present a case of bilateral transudative chylothoraces secondary to sclerosing mesenteritis. CASE PRESENTATION: A previously healthy 66 year old Caucasian woman presented with a year of abdominal discomfort and weight loss. Serpiginous vasculature was noted on upper endoscopy. Computed tomography (CT) of the abdomen demonstrated a large calcified mass at the root of the mesentery in addition to ascites and a right pleural effusion. Initial workup for neuroendocrine cell tumor was negative and biopsy was non-revealing. Due to exertional dyspnea, bilateral thoracenteses were performed with demonstration of turbid, milky appearing, mononuclear cell predominant, transudative chylous pleural effusions. The pleural fluid triglyceride level was >950 mg/dL in each fluid collection. A low-fat diet, Octreotide, and Lasix were initiated with initial improvement. A repeat biopsy of the mass revealed the rare condition of sclerosing mesenteritis. She was started on Prednisone and Tamoxifen with disease stability at six months. Due to symptomatic recurrent pleural effusions despite diet and medication modifications, definitive management is being considered. DISCUSSION: Sclerosing mesenteritis is a rare inflammatory and fibrotic disease, often found incidentally on imaging. The underlying cause is unknown although multiple mechanisms have been postulated. Symptoms range from asymptomatic to inflammatory and/or obstructive symptoms. Chylous ascites can occur in up to 14% of patients. A chylous pleural effusion has only been reported in two cases. One was noted at autopsy and the other was unilateral and transudative in etiology, with concern for concurrent heart disease. As our patient has no significant medical co-morbidities, the bilateral chylothoraces are likely due to abdominal lymphatic obstruction and possible diaphragmatic translocation, though in the absence of significant abdominal ascites. To the best of our knowledge, bilateral transudative chylothoraces associated with sclerosing mesenteritis has not previously been reported in the literature. CONCLUSIONS: Sclerosing mesenteritis is an uncommon disorder of the small bowel mesentery. It is an even less common cause of chylothorax, despite being known to cause chylous ascites. In patients with unexplained chylothorax, even if transudative in nature, abdominal imaging should be considered. Reference #1: Rice B, Stoller J, Heresi G. Transudative chylothorax associated with sclerosing mesenteritis. Respiratory Care 2010; 55(5):475-477. Reference #2: Agrawal V, Doelken P, Sahn SA. Pleural fluid analysis in chylous pleural effusion. Chest 2008;133(6):1436-1441. Reference #3: Fujino S, Kohno N, Inoue Y, Fujioka S, Hamada H, Abe M, et al. [A case of chylothorax caused by mesenteric panniculitis]. Nippon Ronen Igakkai Zasshi 1995;32(7):516-519. Article in Japanese. DISCLOSURES: No relevant relationships by Elena Burke, source=Web Response No relevant relationships by Rebecca Krochmal, source=Web Response" @default.
• W2980451754 created "2019-10-25" @default.
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• W2980451754 date "2019-10-01" @default.
• W2980451754 modified "2023-09-27" @default.
• W2980451754 title "A RARE CAUSE OF TRANSUDATIVE CHYLOTHORAX" @default.
• W2980451754 doi "https://doi.org/10.1016/j.chest.2019.08.258" @default.
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