A Case of Chylothorax in Non-Hodgkin Lymphoma

Non-traumatic chylothorax is the abnormal collection of chyle in the pleural space without associated trauma to the thoracic duct. Untreated chylothorax is linked to serious complications and high mortality. A 68-year-old male with a five-year history of systemic hypertension presented with a two-month history of cough, dyspnea, and weight loss. He received seven cycles of chemotherapy indicated for non-Hodgkin lymphoma (NHL) of the left cervical lymph node diagnosed in 2011. Clinical examination revealed generalized lymphadenopathy, a stony dull note on percussion, absent breath sounds on auscultation over the right hemithorax, and splenomegaly on abdominal examination. Blood investigations were normal. Chest radiography showed the right pleural effusion with no mediastinal shift. Positron emission tomography scan revealed right pleural effusion with pleural thickening, mild ascites, mediastinal, axillary, and abdominal lymphadenopathy. Right-sided thoracocentesis revealed a milky white liquid, and analysis showed exudative, lymphocytic, low adenosine deaminase with high triglyceride and no malignant cells. A biopsy of a right inguinal lymph node confirmed an NHL. He was placed on second-line chemotherapy along with dietary fat restriction to medium-chain fatty acids. However, he died in December 2022. Chylothorax in NHL has extensive differential diagnoses, and diagnosis is most often delayed. An interdisciplinary treatment approach will save time and reduce mortality in such conditions.