Chylothorax secondary to lymphoma: diagnosis and management in a clinical case, Paraguay 2024

Abstract

Chylothorax is a rare cause of pleural effusion characterized by the accumulation of chyle in the pleural space due to rupture or obstruction of the thoracic duct or its tributaries. In adults, the most common etiology is malignancy, particularly lymphomas, which account for approximately 70% of non-traumatic cases. We report the case of a 37-year-old woman presenting with progressive dyspnea and interscapular chest pain without a history of trauma. Pleural fluid analysis revealed triglycerides of 751 mg/dL and cholesterol of 67 mg/dL, consistent with chylothorax. The patient was initially managed with pleural drainage; however, due to persistent output, a right thoracotomy with decortication, lavage, and pleurodesis was performed. Histopathological examination confirmed non-Hodgkin lymphoma as the underlying cause. The management of chylothorax focuses on treating the underlying disease and may include conservative measures (fat-free diet, medium-chain triglycerides, octreotide) or surgical intervention for persistent leakage. This case highlights the importance of early diagnosis and a multidisciplinary therapeutic approach in patients with chylothorax associated with lymphoproliferative neoplasms. Spontaneous chylothorax secondary to lymphoma represents a diagnostic and therapeutic challenge. Timely recognition and comprehensive management are essential to reduce morbidity and improve patient outcomes.