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Lung Cancer |

Postoperative Mediastinal Chyloma Following Lobectomy Imitating Lymph Node Metastasis

Canan Gündüz*, MD; Richard Louis Morrison, MD; Tuncay Göksel, MD
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Ege University Faculty of Medicine, Izmir, Turkey


Chest. 2012;142(4_MeetingAbstracts):615A. doi:10.1378/chest.1388811
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Abstract

SESSION TYPE: Cancer Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Patients with lung cancer often have local or distant metastasis at the time of diagnosis. The incidence of local or regional recurrence in operated stage 1 non-squamous cell lung cancers is reported to be 7-15%. Even in early stage disease without systemic or regional lymph node metastases undergoing operation, there is the need for close follow up in the postoperative period in order to detect a possible relapse. Despite newly developing techniques for predicting the risk of local recurrence, histologic examination is still often used for confirmation. Endobronchial ultrasonography (EBUS) is a pioneer diagnostic tool that allows the physician to obtain the much needed tissue sample for evaluating possible lymph node metastasis in lung cancers. Among postoperative complications after thoracic surgery, chylothorax can develop within a few weeks and occurs with a frequency less than 1 percent. Chylomas are cysts that can occur after the initial injury to the thoracic duct.

CASE PRESENTATION: A 54-year-old Turkish male presented with cranial metastatic non-squamous cell lung cancer (T1N0M1), and underwent cranial metastasectomy as well as right upper lobectomy followed by radiotherapy and chemotherapy. Postoperative chylothorax after lobectomy was identified and treated with tube thoracostomy and parenteral nutrition support. Computerized tomography of the thorax six months later revealed subcarinal lymphadenopathy. The lymphadenopathy was suspected to be recurrence of his previous lung cancer. Endobronchial ultrasound guided needle aspiration was performed and revealed milky, white fluid. Cytopathology was reported as a chylous fluid collection. The chyloma was a complication of lobectomy and cylothorax. Our patient has been followed for one year and chyloma has not recurred.

DISCUSSION: There are only a few documented postoperative mediastinal chyloma cases in the literature. A patient with this complication could present with dysphagia or have more severe symptoms signifying mediastinitis. The development of a chyloma after lung resection can originate from thoracic duct injuries. Systematic mediastinal lymph node dissection in our patient might have caused the chylothorax after the initial damage to the thoracic duct.

CONCLUSIONS: Postoperative mediastinal chyloma formation is a rare but an important complication originating from thoracic duct injuries. A chyloma can mimic lymphadenopathy and lead the clinician to suspect malignancy. Our patient had already undergone craniotomy for removal of a solitary metastasis. We expected to diagnose recurrence of his primary lung cancer. Fortunately we were able to use endobronchial ultrasound and obtain a tissue sample for histopathology. We were also able to drain the chyloma by aspiration at the time of EBUS. The chest physician should be aware of this rare, but important complication that could affect medical decisions and patient outcome.

1) Suzuki K, Yoshida J, Nishimura M, Takahashi K, Nagai K. Postoperative Mediastinal Chyloma. Ann Thorac Surg 1999;68:1857- 8.

2) J-J Hung, W-H Hsu, C-C Hsieh, et al. Post-recurrence survival in completely resected stage I non-small cell lung cancer with local recurrence. Thorax 2009;64:192-196.

3) Gomez M, Silvestr G. Endobronchial Ultrasound for Lung Cancer. Proc Am Thorac Soc Vol 6. pp 180-186, 2009.

DISCLOSURE: The following authors have nothing to disclose: Canan Gündüz, Richard Louis Morrison, Tuncay Göksel

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Ege University Faculty of Medicine, Izmir, Turkey

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