A Cause of Bilateral Chylothorax: A Case of Mesothelioma without Pleural Involvement during Initial Diagnosis

Our plain-English summary of A Cause of Bilateral Chylothorax: A Case of Mesothelioma without Pleural Involvement during Initial Diagnosis, by E. Kurtipek, M.İ. Eren Karanis, N. Düzgün, et al (Case Reports in Pulmonology, 2015).

The study

• Authors: E. Kurtipek, M.İ. Eren Karanis, N. Düzgün, H. Esme, M. Çaycı
• Journal: Case Reports in Pulmonology
• Published: 2015;2015:962504
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Chylothorax is characterized by fluid accumulation in the pleural cavity containing chylomicrons due to disruption of lymphatic drainage in the thoracic ductus and development of chylothorax. A 60-year-old male patient presented to our clinic with shortness of breath and displayed bilateral pleural effusion and diffuse mediastinal lymph nodes in his computed chest tomography images. There were no thickening and nodular formation on the pleural surfaces. PET-CT showed no pathological FDG uptake. Thoracentesis showed a chylous effusion. Drainage reduced during monitoring could not be stopped; therefore, surgical intervention was considered. The patient underwent right thoracotomy. There were no pathological findings in the parietal and visceral pleura during the surgery. Initially lymphoma was considered. Perioperative samples were collected from the mediastinal lymph node. The pathology analysis reported metastasis of malignant mesothelioma. Evaluation of a repeated chest computed tomography showed nodular formations on the pleural surfaces. Mediastinal lymph nodes compressed the ductus thoracicus, resulting with chylothorax. The present case, with malignant mesothelioma, bilateral chylothorax, and mediastinal lymph node without any pleural involvement during initial diagnosis, is rare and will hence contribute to the literature.

In plain English

This article was a case report from Konya Training and Research Hospital in Turkey about one 60-year-old man who came to the clinic short of breath. CT scans showed fluid around both lungs but no thickening or nodules on the pleura, the lining of the lungs, and a PET-CT scan showed no abnormal uptake. The fluid was chylous, meaning it contained fat-rich lymph (chylothorax). Drainage did not stop, so the man had surgery on the right side of his chest, during which the thoracic duct was tied off. Surgeons saw no abnormality on the pleura. Lymphoma was first suspected, but tests on mediastinal lymph nodes (in the central chest) led to a diagnosis of metastatic malignant mesothelioma. A CT one month after surgery showed diffuse nodules. Chemotherapy was prescribed, but his poor condition prevented treatment. The authors attributed the chylothorax to tumor affecting the thoracic duct. The article did not report whether this patient had any asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 60-year-old man seen at Konya Training and Research Hospital, Konya, Turkey; dates of care not given
• Exposure: Not reported. The article gives no asbestos or other exposure history for this patient. Asbestos is mentioned only as general background on the causes of malignant pleural mesothelioma.
• Main results:
  • At first presentation, CT showed fluid around both lungs (bilateral pleural effusion) with no pleural thickening or nodules.
  • The fluid drawn from the chest was chylous. Pleural fluid triglyceride was 1228 mg/dL and cholesterol was 149 mg/dL.
  • A repeat CT after drainage showed no pleural thickening or nodules, and PET-CT showed no abnormal FDG uptake.
  • Surgery was planned at day 10 because drainage had fallen below 500 cc but stayed above 250 cc. The patient had a right thoracotomy, and the thoracic duct was tied off just above the diaphragm.
  • During surgery, no abnormality suggesting mesothelioma was seen on the parietal or visceral pleura.
  • Mediastinal lymph node samples showed tumor cells that stained diffusely and strongly for Pan-CK, Calretinin, WT-1, vimentin, CK7, HBME-1 and D2-40. On this basis the patient was diagnosed with metastasis of malignant mesothelioma.
  • A CT at one month after surgery showed diffuse nodular formation.
  • Chemotherapy was prescribed, but the patient could not receive it because of his impaired general condition.
• The authors' conclusion: The authors believed that in this patient, the combination of malignant pleural mesothelioma and bilateral chylothorax was associated with rupture of the thoracic duct caused by tumor invading from the mediastinal pleura into the mediastinum and the duct. The abstract instead states that mediastinal lymph nodes compressed the duct. The authors also stated that malignant pleural mesothelioma should be considered in patients with, in particular, unilateral pleural effusion, pleural thickening and chest pain.

Topics

Medical terms in this study, explained in our Lexicon: Bilateral, Mesothelioma, Pleural Cavity, Pleural Effusion, Mediastinal Lymph Nodes, PET-CT, Thoracentesis, Thoracotomy.

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