Asif Naseer, Waseem Saeed.
Chylothorax in a case of Non-Hodgkin`s Lymphoma.
J Coll Physicians Surg Pak Jan ;13(2):108-10.

A case of asymptomatic 60 years old male diagnosed as Non-Hodgkin’s lymphoma (angioimmunoblastic T-cell type) invading thoracic duct leading to chylothorax is presented. Generally, patients with this moderately aggressive lymphoma are adults who exhibit generalized lymphadenopathy, B-symptoms, polyclonal hypergammaglobulinemia, skin rash and various autoimmune phenomena.

Case Reports: A 60 years old male from Lahore, who had Spigelian hernia and ascites, referred from surgical OPD, was admitted in medical ward for evaluation of pleural effusion and ascites. He was essentially asymptomatic, other than moderate swelling of abdomen and sometimes feeling dragging sensation at epigastric lump on prolonged walking. On clinical examination, he was cachexic male with generalized discrete lymphadenopathy (size 1 –2 cm), right-sided moderate pleural effusion, well healed cicatrix of right inguinal region surgery, spigelian hernia and massive ascites. Chest x-ray showed right-sided pleural effusion. Ultrasound abdomen showed diffuse coarse hepatic echo-texture, chronic left-sided pyelonephritis, lymphadenopathy, gross ascites and moderate right-sided pleural effusion. Diagnostic thoracentesis and paracentesis revealed chylothorax and chylous ascites confirmed on bio chemical analysis with triglyceride of 7.3 and 10.3 mmol/L respectively. Contrast enhanced CT scan of chest and abdomen discovered bilateral pleural effusion (massive on right side) with partial collapse of right lung, massive ascites and massive abdominal lymphadenopathy invading both kidneys and psoas major muscle. Lymph node biopsy (deep cervical region) showed angioimmunoblastic lymphoma. Serum protein electrophoresis and plasma immunoglobulin levels were normal. Complete blood count showed mild anemia with normal differential count. Liver and renal function tests, sputum for AFB, Mantoux test and other baseline investigations were normal. Serum for ANF and RA-factor was negative. Endobronchial biopsy suggested histopathology consistent with acute on chronic inflammation from lower lobe of right lung. He was treated symptomatically during admission, remaining ambulant and afebrile. Subsequently he was referred for Oncologist’s opinion.

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