SESSION TYPE: Pleural Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Chylothorax is caused by accumulation of lymphatic fluid (chyle) into the pleural space1,2,3. Trauma and malignancies are the most common etiologies. Only three cases of chylothorax associated with prostate cancer have been reported in the literature1. Here we are presenting another case of chylothorax due to metastatic prostate carcinoma.
CASE PRESENTATION: 69 years old male with known prostate cancer and undergoing hormonal therapy, presented with progressive dyspnea. CT scan of the chest, abdomen, and pelvis showed moderate left sided pleural effusion and enlarged mediastinal and retroperitoneal lymphadenopathy. Diagnostic thoracentesis was performed and revealed lymphocytic predominant exudative effusion with triglyceride level of 271 mg/dl. Cytologic analysis was positive for metastatic prostate adenocarcinoma. The patient was managed conservatively with aggressive systemic chemotherapy (Arbiterone) and radiation therapy to prevent pleural fluid from re-accumulating.
DISCUSSION: Chyle consists of lymphatic fluid and emulsified fat which is formed in the small intestine and drained into the venous circulation via the thoracic duct. Chylothorax is characterized by elevated triglyceride levels above 110mg/dl.2 Malignancies can cause chylothorax by lymphangitic spread of the tumor or direct invasion of the thoracic duct1. Treatment is usually conservative. Dietary restriction to medium chain fatty acid, Octreotide therapy or total parenteral nutrition help in minimizing the rate of chyle production.Chemoradiation therapy to control the underlying malignancy is the key1,2,3. Radiation therapy not only controls the disease but also creates an inflammatory reaction that leads to fibrosis and obliteration of the leakage site1. Surgical interventions, which involve chemical pleurodesis or surgical ligation of the thoracic duct, can be difficult in cancer patients with poor functional status3.
CONCLUSIONS: Chylothorax secondary to prostate cancer is very rare and carries high mortality. Conservative management with chemotherapy and radiation therapy are the cornerstone in the treatment strategy of this patient.
1) Little NA, Walther PJ. Chylothorax: A rare complication of metastatic prostatic carcinoma. J Urol 1985;134(6):1215-7.
2) McGrath EE, Blades Z, Anderson PB. Chylothorax: Aetiology, diagnosis, and therapeutic options. Respir Med 2010;104(1):1-8.
3) Cigarral C, Montero A, Salas C, Rodriguez G, de la Torre A. Chylothorax due to metastatic prostate carcinoma: an unusual complication. Clin Transl Oncol 2009;11(11):767-9.
DISCLOSURE: The following authors have nothing to disclose: Hanine Inaty, Maher Tabba
No Product/Research Disclosure InformationTufts Medical Center, Boston, MA