DrVirgo
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A 58-year-old man comes to the clinic complaining of
shortness of breath. He described the dyspnea as gradual
in onset over the last few weeks. The patient denies
any pleuritic pain, cough, or orthopnea, and has no
previous cardiac or respiratory medical history. Review
of systems, however, is concerning for an unexplained
20-lb weight loss over the last few months and intermittent
fevers and night sweats. The patient does not
smoke cigarettes currently, though he has a distant 20
pack-year history. He denies using illicit substances and
only rarely drinks alcohol. He has not had any major
illnesses in the past, has had no major operations, and
is employed as an accountant. Physical examination is
remarkable for reduced breath sounds and dullness to
percussion approximately halfway up the right
hemithorax. Chest radiograph confirms a right-sided
pleural effusion and some hilar and mediastinal lymphadenopathy.
A diagnostic thoracentesis is performed
that reveals a milky-white, opalescent fluid. Laboratory
studies reveal this fluid to have a markedly elevated
triglyceride level of 558 mg/dL, a high cell count composed
mainly of T lymphocytes, and numerous chylomicrons.
Cytologic examination is unremarkable.
Which of the following is the most likely cause of this
patient’s effusion?
(A) Infection with acid-fast organisms
(B) Lymphangioleiomyomatosis (LAM)
(C) Non-Hodgkin lymphoma
(D) Pancreatic adenocarcinoma
(E) Undiagnosed mesothelioma
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| nadiabarati
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A?
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| doc_clotaire
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C ) Non-Hodking lymphoma .
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| sarika
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milky white B) Lymphangioleiomyomatosis (LAM
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| DrVirgo
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The correct answer is C. This patent has a chylous effusion,
defined as a lymphatic leak into the pleural space.
There are a variety of causes of chylous effusions, falling
mainly into the categories of traumatic and nontraumatic.
Traumatic causes include surgery, in which the thoracic
duct can be nicked (this patient has no surgical history)
and thoracic trauma. Nonsurgical causes include
infection and, much more commonly, malignancy. The
most common malignancy to cause a chylothorax is lymphoma,
as hinted at by this patient’s B-symptoms and
abnormal chest radiograph.
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| Guptashutosh
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but how will u r/o LAM here , kindly explain
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| Guptashutosh
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Posts: 354
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cytology is unremarkable , more so NHL will have increased LDH , i think diag here stands more 4 LAM, we need to r/o it 1st
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| DrVirgo
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Lymphangioleiomyomatosis (choice B) is an extremely
rare disease that affects women of childbearing age and
may cause chylous effusions. It is an unlikely diagnosis
in this middle-aged man.
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