CRA102 BEYOND THE MILKY PLEURAL FLUID: A CASE SERIES

Sook Ling Low¹, Nurhayati Mohd Marzuki¹, Zamzurina Abu Bakar, Syazatul Syakirin Sirol Aflah¹, Nabilah Bt Salman Parasi¹, Nor Suraya Bt Samsudin¹

¹Institut Perubatan Respiratori, Kuala Lumpur, Malaysia

Chylothorax is a rare condition characterized by the accumulation of chyle in the pleural space. Its clinical presentation varies and carries high morbidity and mortality. Hence, it is essential to conduct comprehensive clinical assessments, pleural fluid analysis, and imaging studies, such as computed tomography and/or lymphangiography, to identify the cause of chylothorax.

In this case series, we present five patients with biochemically proven chylothorax, each with a different presentation, underlying cause, management strategy, and clinical outcome. The first patient developed chylothorax secondary to Tuberous sclerosis complex-lymphangioleiomyomatosis (TSC-LAM), while the second patient's chylothorax is related to Sporadic-lymphangioleiomyomatosis (S-LAM). The third patient's chylothorax is due to Hodgkin lymphoma, while the fourth patient is due to superior vena cava thrombosis. The final patient suffered from chylothorax in the setting of pulmonary tuberculosis. To provide symptomatic relief, drainage of chylous effusion was done via intercostal drain for all patients. Three out of five patients required pleurodesis (either chemically or surgically). All patients were placed on medium-chain triglyceride oil and a low-fat diet. Treatment plans were individualized according to the specific etiology of each case.

This case series illustrated the broad spectrum of potential causes of chylothorax. Despite chylothorax being a rare entity, early recognition, diagnosis, thorough workup, and prompt treatment can significantly lower morbidity and complications and improve quality of life.