Abstract Chylous effusions are uncommon, and the simultaneous occurrence of chylothorax with chylous ascites is exceptionally rare. Chyle is a triglyceride rich lymphatic fluid that appears milky in character, and the diagnosis is usually confirmed via thoracentesis or paracentesis, with triglyceride levels exceeding 110 mg/dL. We report a patient with a history of testicular cancer status post-orchiectomy and extensive retroperitoneal lymph node dissection who developed recurrent chylous effusions. Diagnostic fluid analysis confirmed chylous character, and fluid cytology confirmed diagnosis of B-cell lymphoma. The patient ultimately underwent robotic-assisted thoracoscopic surgery (RATS), including pleurodesis and pleurectomy, and was initiated on chemotherapy with Rituximab. This case illustrates an unusual mechanism in which chyle translocates from the peritoneal cavity to the pleural space via diaphragmatic lymphatic channels due to lymphatic obstruction from malignancy or from prior surgical disruption. Recognition of this mechanism is critical, as concurrent chylous ascites and chylothorax may mimic other causes of effusions and could lead to unnecessary thoracic interventions. Early identification allows targeted diagnostic imaging and management, including addressing the underlying malignancy, dietary modification, or pharmacologic therapy to effectively control chylous effusions. This case emphasizes the importance of maintaining a high index of suspicion for systemic lymphatic disruption in patients presenting with concurrent chylous effusions, particularly in the context of prior malignancy or lymph node surgery. This abstract is funded by: none
John et al. (Fri,) studied this question.