Bilateral idiopathic chylothorax associated with light physical exercise

Summary 

Chylothoraces are associated with multiple etiologies including non-Hodgkin lymphoma and intrathoracic surgical trauma. In about 15% of cases no reason can be found for the chylous pleural effusion: most of these idiopathic chylothoraces are thought to be related to minor trauma. We present a case of bilateral idiopathic chylothorax temporally associated with light physical exercise.

A 74-year-old woman was brought to the hospital for evaluation of dyspnea and right-sided pleuritic chest pain. A chest roentgenogram demonstrated bilateral pleural effusion. The patient reported that the pain at the right side of her chest started abruptly 48h prior to admission, when she twisted right and hyperextended her spine to take up an object from the floor. Routine laboratory studies were within normal limits. Thoracentesis yielded a creamy–milky appearing fluid, with elevated tryglicerides levels (>575mg/dL). A computed tomography scan of the chest and abdomen was normal, except for the bilateral pleural effusion. After 72h of rest and low-fat diet the effusion completely resolved.

Idiopathic chylothorax in adults is an uncommon type of pleural effusion. Its diagnosis requires to rule out other etiologies. The treatment of choice is conservative.

Keywords: Idiopathic chylothorax, Chylothorax, Pleural effusion, Spontaneous chylothorax, Thoracic duct