Medical image of the week: Chylothorax

• Main Authors: Dicken J, Chopra M, Jaffer F, Snyder L
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2018-08-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: chylothorax; CT scan; milky; triglycerides; adenocarcinoma; lung cancer; dyspnea; pleural effusion; lymphadenopathy; mediastinal lymphadenopathy
• Online Access: http://www.swjpcc.com/imaging/2018/8/8/medical-image-of-the-week-chylothorax.html

No abstract available. Article truncated after 150 words. A 73-year-old man with untreated stage IV adenocarcinoma of the lung was admitted to the hospital with several days of progressively worsening dyspnea on exertion. The chest CT showed a large left pleural effusion with enlarging bilateral hilar and mediastinal lymphadenopathy, compression of the superior vena cava and right main pulmonary artery consistent with progressive lung cancer (Figure 1). Therapeutic and diagnostic left sided thoracentesis was performed, removing approximately 450 ml of milky, pink fluid suggestive of hemochylothorax (Figure 2). Analysis of the fluid was significant for 27,720 red blood cells, 476 total nucleated cells with lymphocyte predominance (87%), glucose 158 mg/dl, cholesterol 63 mg/dl, and amylase 28 U/L. The pleural fluid was exudative (protein 4.4 g/dl) with a significantly elevated triglyceride level of 532 mg/dl. No malignant cells were identified in the fluid. This case illustrates a nontraumatic chylothorax secondary to metastatic adenocarcinoma of the lung. The leading cause …