Unusual presentation of chylothorax secondary to a giant abdominal mass

Abstract

Chylothorax is an under recognized cause of pleural effusion, especially when not associated with trauma or malignancy or whenthe fluid is not milky in appearance. Without proper recognition, chylothorax can lead to significant morbidity and mortality.We present the case of a 77-year-old female with a large intra-abdominal cystic mass. A right pleural effusion was presenton a pre-operative computed tomography scan. After laparotomy and resection, the mass was identified as a benign ovariancystadenoma, and a small-bore chest tube was placed. The effusion was initially exudative, but transitioned to a transudate.Further workup revealed the presence of chylomicrons and a diagnosis of chylothorax was made. The patient had secondarycomplications including severe lower extremity lymphedema, right hemi-diaphragm elevation, and stenosis of the intrahepaticinferior vena cava. She also had cirrhosis, anasarca, and concomitant severe aortic stenosis. The patient opted to be discharged onhospice care and passed away a week later. Chylothorax should be considered in any patient despite clear pleural effusion. Largeabdominal masses may cause chylothorax and should be part of the differential diagnosis.