%0 Journal Article
%T Persisting right-sided chylothorax in a patient with chronic lymphocytic leukemia: a case report
%A Godehard A Scholz
%A Horia Sirbu
%A Sabine Semrau
%A Katharina Anders
%A Andreas Mackensen
%A Bernd M Spriewald
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-492
%X We present the case of a 65-year-old male Caucasian patient with right-sided chylothorax caused by a concomitantly diagnosed chronic lymphocytic leukemia. As first-line treatment four cycles of an immunochemotherapy, consisting of fludarabine, cyclophosphamide and rituximab were administered. In addition, our patient received total parenteral nutrition for the first two weeks of treatment. Despite the very good clinical response of the lymphoma to treatment, the chylothorax persisted and percutaneous radiotherapy of the thoracic duct was applied. However, eight weeks after the radiotherapy the chylothorax still persisted and our patient agreed to a surgical intervention. A ligation of the thoracic duct via a muscle sparing thoracotomy was performed, resulting in a complete cessation of the pleural effusion. Apart from the first two weeks our patient was treated on an out-patient basis for nearly six months.In this case of chylothorax caused by chronic lymphocytic leukemia, immunochemotherapy in combination with conservative treatment, and even consecutive radiotherapy, were not able to stop pleural effusion, despite the very good clinical response of the chronic lymphocytic leukemia to treatment.Out-patient management using repetitive thoracocenteses can be safe as bridging until definitive surgical ligation of the thoracic duct.Chylothorax is a rare condition defined by chyle entering the pleural space, caused by a disruption or blockade of the thoracic duct [1]. The pleural effusion is usually of milky white appearance due to a high lipid concentration. To distinguish chylothorax from nonchylous effusions, such as pseudochylothorax, the triglyceride level is determined. A triglyceride level greater than 110 mg/dL is highly suggestive of a chylous effusion. In cases where triglycerides range between 50 mg/dL and 110 mg/dL, a diagnosis of chylothorax can be made using lipid electrophoresis to detect the presence of chylomicrons [2,3].Disruption of the thoracic duct
%U http://www.jmedicalcasereports.com/content/5/1/492