A47-18 Hepatic Chylothorax as the Initial Presentation of Decompensated Hepatitis C Cirrhosis

Abstract Introduction Hepatic hydrothorax is a recognized complication of advanced cirrhosis and typically presents as a transudative pleural effusion. Chylothorax, in contrast, is usually exudative and arises from trauma, lymphoma, or thoracic duct obstruction. We report a rare case of transudative chylothorax as the initial manifestation of previously undiagnosed hepatitis C-related cirrhosis. Case Description A 55-year-old man with untreated hepatitis C infection and no known history of cirrhosis presented with progressive dyspnea and 10 kg weight loss over two months. He was a 40 pack-year smoker. Examination revealed reduced right-sided air entry, and chest radiography showed a large right pleural effusion with contralateral mediastinal shift. Thoracentesis yielded markedly milky white pleural fluid. Fluid analysis was transudative by Light’s criteria, with elevated triglycerides of 2.64 mmol/L, diagnostic of chylothorax- an unusual finding given the transudative profile. Pleural fluid cytology and cultures were negative. Computed tomography of the thorax, abdomen, and pelvis demonstrated cirrhotic morphology of the liver, splenomegaly, and ascites consistent with portal hypertension. A diagnosis of newly diagnosed decompensated hepatitis C cirrhosis presenting with hepatic hydrothorax complicated by chylothorax was made. The chest drain was removed, diuretic therapy was initiated, and the patient was referred to hepatology for further management of his hepatitis C cirrhosis. Discussion Chylothorax classically presents as an exudative effusion due to disruption of lymphatic drainage, whereas hepatic hydrothorax presents as a transudative effusion. This case is unusual because the pleural fluid was both chylous and transudative, reflecting the pathophysiology of cirrhosis with portal hypertension. This case highlights that transudative chylothorax should be recognized as an important diagnostic clue to underlying systemic pathologies such as cirrhosis. This abstract is funded by: None