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A patient with chronic lymphocytic leukemia (CLL) developed chylothorax due to thoracic duct obstruction. Abnormal lymphocytes likely caused the blockage, leading to chyle accumulation.

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Area of Science:

  • Hematology
  • Pulmonology
  • Oncology

Background:

  • Chronic lymphocytic leukemia (CLL) is a common hematologic malignancy.
  • Chylothorax, the accumulation of chyle in the pleural space, can occur due to various causes, including malignancy.
  • Complete remission in CLL does not preclude the development of other complications.

Observation:

  • An 80-year-old male with a history of CLL in complete remission presented with right-sided pleural effusion.
  • Thoracentesis confirmed the effusion to be chyle.
  • Lymphoscintigraphy identified an obstruction in the thoracic duct below the sternum.

Findings:

  • Flow cytometry of the pleural fluid revealed elevated CD5- and CD23-positive lymphocytes, characteristic of CLL.
  • A high serum level of soluble interleukin-2 receptor was also noted.
  • These findings suggest the chylothorax resulted from thoracic duct obstruction by abnormal CLL lymphocytes or potentially transformed lymphoma cells.

Implications:

  • This case highlights a rare complication of CLL, emphasizing the need for vigilance even in remission.
  • The findings suggest that sludging of malignant lymphocytes can obstruct lymphatic flow, leading to chylothorax.
  • Further investigation may be warranted to understand the mechanisms of lymphatic obstruction in hematologic malignancies.