A case of chylothorax due to diffuse large B-Cell lymphoma

Abstract

A 66-year-old male patient with was admitted to hospital with complaints of fatigue and shortness of breath. In the chest X-ray of the patient, homogeneous density increase was observed in the lower zone of the right lung, suggesting pleural effusion and showing Damoiseau's line. In the patient who underwent thoracentesis, pleural fluid in the form of yellow pus and empyema was seen. The pleural fluid biochemistry was in the character of exudate. Thoracic computed tomography (CT) was performed in the patient who underwent closed underwater drainage with tube thoracostomy. Pleural effusion was reaching 8 cm. in the right hemithorax. The size of the spleen was increased, the liver parenchyma was heterogeneous. In the follow-ups, although the pleural effusion and Damoiseau line of the patient were erased, the fluid continued to come out of the drain as a daily empyema; the patient's clinical and laboratory tests were not compatible with empyema. In addition, a possible hematological malignancy was considered due to low Hb, leukocyte, platelet levels, and hepatosplenomegaly. Chylothorax was taken into the differential diagnosis and triglyceride and cholesterol were sent from the pleural fluid. Triglyceride was high in pleural fluid. No malignant cells were seen in pleural fluid cytology. Positron emission tomography (PET)/CT was performed to determine the etiology in the patient who was diagnosed with chylothorax. There were dense hypermetabolic lymphadenopathy masses starting from the level of the 8th thoracic vertebra up to the retrocrural area in the prevertebral area. Spleen sizes were increased and there were intense hypermetabolic involvements. Involvement due to lymphoproliferative diseases was considered in the foreground. Mediastinoscopy was performed. Biopsies were taken from mass in the paraesophageal area (posterior mediastinum). The pathology result of the biopsies was "Diffuse Large B-Cell Lymphoma". The patient was referred to hematology and oncology clinics for treatment and discharged.