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Chylous ascites and chylothorax: a case study.

Mehta AA, Gupta R, Balamugesh T, Christopher DJ - Libyan J Med (2010)

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

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A 40-year-old male patient was admitted with the symptoms of progressive dyspnea, orthopnea, and abdominal distension of 2 months duration... Chest X-ray posteroanterior (PA) view showed bilateral pleural effusion and pericardial effusion... No lymphadenopathy or tumors were detected during abdominal CT... Chylous pleural effusion (Chylothorax) is usually secondary to disruption of the thoracic duct or derangement of lymphatic flow within the thorax... Chylous ascites is associated most frequently with malignant conditions such as lymphomas and disseminated carcinomas from primaries in the pancreas, breast, colon, prostate, ovary, testes, and kidney... In some patients, chylothorax occurs in the setting of chylous ascites, which in turn is related to a primary abdominal process such as nephrotic syndrome, hypothyroidism, cirrhosis of the liver, abdominal operations, and pancreatitis... In our patient, CT of thorax and abdomen were not contributory... Signet ring cell adenocarcinoma is most common in the stomach followed by the colon... There is only one report where primary have been found in the lung... However, in view of poor general condition of the patient invasive procedures like endoscopy or bronchoscopy were not possible... Chylothorax with chylous ascites associated with pericardial effusion is a rare finding... There are only few published case reports of chylothorax and chylous ascites occurring together... Among them, one case of chylothorax with chylous ascites due to metastatic carcinoma of lung, one due to constrictive pericarditis, and the rest due to metastatic carcinoma of stomach... We would like to conclude that chylothorax with chylous ascites in background of malignant pericardial effusion is a rare scenario.

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Figure 0001: Showing signet ring cell adenocarcinoma under high power field.

Mentions: Laboratory findings revealed elevated serum creatinine (2.0 mg/dl) with normal hematocrit, liver function test (LFT), and electrolyte. Chest X-ray posteroanterior (PA) view showed bilateral pleural effusion and pericardial effusion. Thoracocentesis yielded a milky fluid with the following biochemical composition: total protein 3.6 g/dl, albumin 2.0 g/dl, glucose 118 mg/dl, and LDH 121 U/l. Cell count of the fluid showed 1,300/mm3 of WBCs; of which 96% were lymphocytes and 4% polymorphs, triglycerides 411 mg/dl, cholesterol 70 mg/dl, and chylomicron 260 mg/dl. Pleural fluid cytology showed atypical cells and closed pleural biopsy revealed non-specific chronic inflammation. Cultures of the fluid including mycobacterial culture, of peritoneal and pleural fluid were non-contributory. Two dimensional (2D) ECHO-cardiograph showed moderate pericardial effusion with collapse of right atrium and right ventricle, suggesting cardiac tamponade. Pericardiocentesis was done immediately which revealed hemorrhagic fluid. Pericardial fluid cytology showed atypical cells suggestive of malignancy, although biochemical analysis confirmed that it was not chylous. The fine needle aspiration cytology (FNAC) of the axillary lymph node revealed signet ring cell adenocarcinoma (Fig. 1). Computed tomography (CT) of the thorax was done after thoracocentesis to find out the possible etiology. It showed bilateral pleural effusion, pericardial effusion, paratracheal, and mediastinal lymph nodes up to 8 mm with a calcified granuloma in the left upper lobe (Fig. 2). FNAC of these lymph nodes were not done in view of smaller size of lymphnode. Abdominal ultrasonography and CT of the abdomen showed left sided hydorneprhosis with moderate ascites. No lymphadenopathy or tumors were detected during abdominal CT. Other investigations to locate primary such as fiberoptic bronchoscopy, upper GI endoscopy, and colonoscopy could not be done due to unfavorable physical condition. The final diagnosis was metastatic signet ring cell adenocarcinoma of unknown primary with chylothorax, chylous ascites, and probably malignant pericardial effusion.


Chylous ascites and chylothorax: a case study.

Mehta AA, Gupta R, Balamugesh T, Christopher DJ - Libyan J Med (2010)

Showing signet ring cell adenocarcinoma under high power field.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3066756&req=5

Figure 0001: Showing signet ring cell adenocarcinoma under high power field.
Mentions: Laboratory findings revealed elevated serum creatinine (2.0 mg/dl) with normal hematocrit, liver function test (LFT), and electrolyte. Chest X-ray posteroanterior (PA) view showed bilateral pleural effusion and pericardial effusion. Thoracocentesis yielded a milky fluid with the following biochemical composition: total protein 3.6 g/dl, albumin 2.0 g/dl, glucose 118 mg/dl, and LDH 121 U/l. Cell count of the fluid showed 1,300/mm3 of WBCs; of which 96% were lymphocytes and 4% polymorphs, triglycerides 411 mg/dl, cholesterol 70 mg/dl, and chylomicron 260 mg/dl. Pleural fluid cytology showed atypical cells and closed pleural biopsy revealed non-specific chronic inflammation. Cultures of the fluid including mycobacterial culture, of peritoneal and pleural fluid were non-contributory. Two dimensional (2D) ECHO-cardiograph showed moderate pericardial effusion with collapse of right atrium and right ventricle, suggesting cardiac tamponade. Pericardiocentesis was done immediately which revealed hemorrhagic fluid. Pericardial fluid cytology showed atypical cells suggestive of malignancy, although biochemical analysis confirmed that it was not chylous. The fine needle aspiration cytology (FNAC) of the axillary lymph node revealed signet ring cell adenocarcinoma (Fig. 1). Computed tomography (CT) of the thorax was done after thoracocentesis to find out the possible etiology. It showed bilateral pleural effusion, pericardial effusion, paratracheal, and mediastinal lymph nodes up to 8 mm with a calcified granuloma in the left upper lobe (Fig. 2). FNAC of these lymph nodes were not done in view of smaller size of lymphnode. Abdominal ultrasonography and CT of the abdomen showed left sided hydorneprhosis with moderate ascites. No lymphadenopathy or tumors were detected during abdominal CT. Other investigations to locate primary such as fiberoptic bronchoscopy, upper GI endoscopy, and colonoscopy could not be done due to unfavorable physical condition. The final diagnosis was metastatic signet ring cell adenocarcinoma of unknown primary with chylothorax, chylous ascites, and probably malignant pericardial effusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 40-year-old male patient was admitted with the symptoms of progressive dyspnea, orthopnea, and abdominal distension of 2 months duration... Chest X-ray posteroanterior (PA) view showed bilateral pleural effusion and pericardial effusion... No lymphadenopathy or tumors were detected during abdominal CT... Chylous pleural effusion (Chylothorax) is usually secondary to disruption of the thoracic duct or derangement of lymphatic flow within the thorax... Chylous ascites is associated most frequently with malignant conditions such as lymphomas and disseminated carcinomas from primaries in the pancreas, breast, colon, prostate, ovary, testes, and kidney... In some patients, chylothorax occurs in the setting of chylous ascites, which in turn is related to a primary abdominal process such as nephrotic syndrome, hypothyroidism, cirrhosis of the liver, abdominal operations, and pancreatitis... In our patient, CT of thorax and abdomen were not contributory... Signet ring cell adenocarcinoma is most common in the stomach followed by the colon... There is only one report where primary have been found in the lung... However, in view of poor general condition of the patient invasive procedures like endoscopy or bronchoscopy were not possible... Chylothorax with chylous ascites associated with pericardial effusion is a rare finding... There are only few published case reports of chylothorax and chylous ascites occurring together... Among them, one case of chylothorax with chylous ascites due to metastatic carcinoma of lung, one due to constrictive pericarditis, and the rest due to metastatic carcinoma of stomach... We would like to conclude that chylothorax with chylous ascites in background of malignant pericardial effusion is a rare scenario.

No MeSH data available.


Related in: MedlinePlus