Abstract Introduction Chylothorax, where lymphatic fluid accumulates in the pleural space, is a rare condition accounting for a small percentage of pleural effusions.1 Injury or disruption to the thoracic duct most commonly results from trauma, surgery and malignancy, with lymphoma the most common malignancy, accounting for up to 70% of non-traumatic chylothoraces.1 Rarer causes include infections (TB,NTM, filariasis, histoplasmosis) and lymphatic disorders .Chylous ascites, similarly, is the presence of chyle in the peritoneal cavity. The etiology is similar to chylothorax, with liver cirrhosis another potential cause.2Diagnosis of chylothorax and chylous ascites confirmed by the presence of elevated triglyceride levels in fluid .Clinical presentation of both conditions varies, management strategies including dietary modifications, pharmacological intervention, drainage of fluid and treatment of the underlying causes. Case Presentation A 56 year old gentleman from Caribbean ,non smoker, referred to the pulmonology clinic with one month history of dyspnea, weight loss and anorexia. Clinical examination suspicious for a right sided pleural effusion and this was confirmed with chest radiograph and thoracic ultrasound. A chest drain inserted with milky pleural fluid obtained; chylothorax was confirmed on fluid analysis with raised triglycerides (482.4mg/dL).CT showed a anterior mediastinal mass and a retroperitoneal mass encasing multiple abdominal structures, as well as ascites. A FDG-PET-CT confirmed FDG avid lymphadenopathy and soft tissue thickening above and below the diaphragm.Bloods were significant for microcytic anemia; a hemoglobin electrophoresis showed a new diagnosis of minor beta-thalassemia. Histopathological investigations to date include cytological analysis of the pleural fluid and biopsies of an external iliac lymph node, the mediastinal mass, retroperitoneal nodal tissue and bone marrow. Results are suggestive of a high grade lymphoma, but not confirmed yet.The patient has required a left thoracic drain and an ascitic drain for symptomatic relief, with drainage of large amounts of chylous fluid. Discussion Chylothorax and chylous ascites are rare conditions with a paucity of high quality evidence or standardised guidelines for management. In this case, while a high grade lymphoma is suspected, diagnostic certainty is yet to be achieved. The significant of thalassemia is uncertain; case report data exists of intrathoracic extramedullary hematopoiesis and pleural effusions in patients with thalassemia, but chylothorax is not known to be associated with thalassemia.3 References: 1. Bhatnagar M, Fisher A,. Chylothorax: pathophysiology, diagnosis, and management-a comprehensive review. J Thorac PMID: 38505027; PMCID: PMC10944732. 2.Mahajan A, Sankhyan P. Bilateral Chylothorax and Chylous Ascites: A Rare Presentation of an Uncommon Disorder. PMID: 33898130; PMCID: PMC8059777. This abstract is funded by: None
Raza et al. (Fri,) studied this question.