Chylothorax - Modalities of management and outcomes: A case series

Aggressive Management of a Bilateral Chylothorax Complicating an Orthotopic Heart-Kidney Transplantation

Chylothorax after an orthotopic heart transplant is a rare but potentially detrimental occurrence. This is the first reported case of bilateral chylothorax complicating a heart-kidney transplant patient. No universally accepted protocol exists for the management of chylothorax in general population, let alone the immunocompromised transplant patient. This case presents unique challenges to the management of postoperative chylothorax given heart-kidney transplant's effect on the patient's volume status and immunocompromised state. We make the argument for aggressive treatment of chylothorax in an immunocompromised heart-kidney transplant patient to limit complications in a patient population predisposed to infection.

Cystic lung disease lymphangioleiomyomatosis (LAM) in a male patient

Lymphangioleiomyomatosis (LAM) is characterised by the proliferation of abnormal smooth muscle cells (LAM cells) in the lungs, lymph nodes and other organs. We report the case of a man in his 50s who had right-sided pleural effusion. On performing a diagnostic tap, the fluid was milky white in colour. An intercostal chest tube was inserted and after complete drainage of fluid, a high-resolution CT (HRCT) was done. HRCT revealed multiple cysts throughout both of the lungs. On subsequent bronchoscopy-guided transbronchial lung biopsy and histochemical staining, diagnosis of LAM was made. We started the patient on oral sirolimus. On subsequent follow-up, subjective and objective improvements were observed.

Atypical nontraumatic chylothorax in a monoclonal IgM elevated nodal marginal zone lymphoma: A case report and review of the literature

Nodal Marginal Zone Lymphoma(NMZL) is an indolent lymphoma with a very low clinical incidence and is sometimes difficult to differentiate diagnostically from Lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia (LPL/WM). NMZL with elevated monoclonal immunoglobulin M (IgM) is even rarer. Nontraumatic chylothorax can be seen in aggressive lymphoma, which often happens with chest tightness and dyspnea as the primary clinical manifestation. We reported the first case of monoclonal IgM elevated NMZL complicated by atypical nontraumatic chylothorax. A 64-year-old male patient was first admitted to the Department of Respiratory Medicine with symptoms of chest tightness and shortness of breath. He was given several times thoracentesis to drain pleural effusion to improve pulmonary compression symptoms. The patient had a combination of elevated monoclonal IgM and atypical lymph node biopsy pathology. After two times lymph node biopsies and genetic testing, the patient was finally diagnosed with NMZL. Within a short time, he was admitted to the Department of Hematology due to the reappearance of massive pleural effusion, which indicated chylothorax. The patient repeatedly presented with left-sided pleural effusion, and the color went from red to yellow, and finally white. Only about half of the chylothorax cases present with typical clinical manifestations. We report this case intending to draw the attention of clinicians to hematologic malignancies with atypical nontraumatic chylothorax.

Non-conservative Management of Chylothorax

Chylothorax is caused by lymphatic leakage, which can develop after thoracic surgery and is associated with cancer. Although prospective randomized trials have not been performed, radiological interventions have been performed in several cases with persistent chylothorax, adjunct to 2 weeks of conservative management. The success rate of such interventions is diverse due to anatomical variations, although the results are promising. However, in cases of treatment failure after cycles of interventions, a team approach may be necessary to determine whether surgical management is warranted.