SHM Converge Scientific Abstract ePoster Gallery-A Rare Complication of Cirrhosis: Transudative Chylothorax

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This case report describes a rare complication of cirrhosis: transudative chylothorax. Chylothorax is usually an exudative pleural effusion caused by thoracic duct injury or obstruction, but in cirrhotic patients it can rarely present as a transudate, often in the setting of hepatic hydrothorax.<br /><br />The patient was a 57-year-old man with NASH cirrhosis complicated by hepatic encephalopathy and recurrent right-sided pleural effusions. He presented with worsening shortness of breath and required thoracentesis, which removed two liters of pink, milky fluid that looked different from prior effusions. Pleural fluid testing showed features consistent with a transudate, including a pleural-to-serum LDH ratio of 0.6 and protein ratio of 0.5, while triglycerides were elevated at 205 mg/dL, supporting chylothorax.<br /><br />Imaging with chest CT and abdominal ultrasound showed rapid re-accumulation of pleural fluid but no ascites, lymphadenopathy, malignancy, or thoracic duct abnormality. The proposed mechanism is increased portal and splanchnic lymphatic pressure from cirrhosis, which may cause leakage of chyle into the pleural space.<br /><br />Management is usually conservative, including low-fat, high-protein diet with medium-chain fatty acids, octreotide, thoracentesis, and sometimes total parenteral nutrition. In this case, the patient received subcutaneous octreotide for five days, was placed on a low-fat diet, and underwent partial splenic artery embolization to reduce portal pressure.<br /><br />The authors note that only about 20 cases have been reported in the literature. Because chylothorax in cirrhosis is associated with increased morbidity and mortality, early recognition and treatment are important.

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Miko De Bruyn

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Author List Amisha S. Mehta, Andrea Martinez, Daniel D. Dressler, Fiyinfoluwa O. Abraham, Kevin P. Shah, Miko De Bruyn, Punit A. Vachharajani, Ryan M. Ford

Category Clinical Vignettes

Concept Transudative Chylothorax

Concept Cirrhosis

Concept Pleural Fluid Analysis

Concept Portal Hypertension

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine J. Willis Hurst Internal Medicine Residency Program

Presenting Author Miko De Bruyn

Track Adult

Keywords

cirrhosis

transudative chylothorax

hepatic hydrothorax

NASH cirrhosis

pleural effusion

octreotide

thoracentesis

portal hypertension

medium-chain fatty acids

partial splenic artery embolization

Transudative Chylothorax

Cirrhosis

Pleural Fluid Analysis

Portal Hypertension

Pleural Effusion