Fangsaard Panisara, Puriwekin Jirapa, Phattraprayoon Nanthida, Ungtrakul Teerapat
Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.
Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.
Case Rep Oncol. 2022 Jun 10;15(2):611-616. doi: 10.1159/000525060. eCollection 2022 May-Aug.
Chylothorax is a lymphatic fluid, which is contained in the pleural cavity. Chylothorax has a typical milky white fluid appearance and is diagnosed by triglyceride concentrations >110 mg/dL. The combination of chylothorax with chylous ascites is a rare condition that is difficult to manage. We present a case of a 60-year-old man who presented with dyspnea for 1 week and generalized abdominal distention. He was diagnosed with advanced-stage pancreatic adenocarcinoma and received palliative chemotherapy. On follow-up examination, he showed decreased breathing sounds in both lungs and marked ascites. Chest radiography showed bilateral pleural effusion, which was more prominent in the left hemithorax than the right hemithorax. Thoracocentesis and abdominal paracentesis were performed, and the finding of pleural and ascites fluid was compatible with bilateral chylothorax and chylous ascites. Although the patient was receiving dietary modification, he still required repeated thoracentesis. Bilateral chest tube insertion with medical pleurodesis with talc successfully treated his chylothorax. This treatment should be considered as an option for malignancy-associated chylothorax besides systemic cancer treatment to improve patients' quality of life.
乳糜胸是一种存在于胸腔内的淋巴液。乳糜胸具有典型的乳白色液体外观，通过甘油三酯浓度>110mg/dL进行诊断。乳糜胸合并乳糜性腹水是一种罕见且难以处理的病症。我们报告一例60岁男性患者，其因呼吸困难1周及全身腹胀就诊。他被诊断为晚期胰腺腺癌并接受了姑息化疗。在随访检查中，他双肺呼吸音减弱且有明显腹水。胸部X线检查显示双侧胸腔积液，左侧胸腔比右侧胸腔更明显。进行了胸腔穿刺和腹腔穿刺，胸腔积液和腹水检查结果符合双侧乳糜胸和乳糜性腹水。尽管患者接受了饮食调整，但仍需要反复胸腔穿刺。双侧胸腔置管并使用滑石粉进行胸膜固定术成功治疗了他的乳糜胸。除了全身性癌症治疗外，这种治疗应被视为改善恶性肿瘤相关性乳糜胸患者生活质量的一种选择。
