A rare coincidence of a chylothorax and a hydrothorax caused by gastric adenocarcinoma – a case report

Česká verzia

Authors: Nela Šťastná ^1,2; doc. MUDr. Kristián Brat, Ph.D. ^1,2
Authors place of work: Klinika nemocí plicních a TBC, Fakultní nemocnice Brno ¹; Lékařská fakulta Masarykovy Univerzity, Brno ²
Published in the journal: Vnitř Lék 2020; 66(7): 43-45
Category: Case Report

Summary

We present a case report of a 74-years old patient with a finding of bilateral pleural effusion due to a different fluid composition caused by gastric adenocarcinoma. The finding of a bilateral effusion, where the exudate fluid is of a different chemical composition, is a rare phenomenon. While the right-sided exudate had the characteristics of hydrothorax, the left-sided exudate had those of chylothorax. The initial suspicion of a lung tumor was not confirmed, and further examination surprisingly revealed gastric adenocarcinoma. The patient did not benefit from targeted oncological treatment for a long time and the chemotherapy was terminated after 3 cycles. The cause of right-sided hydrothorax is therefore attributed to hypalbuminemia and secondary pneumonia, left-sided chylothorax was a primo-manifestation of gastric adenocarcinoma. There is only a small number of similar case reports of patients with gastric tumor and chylothorax in the literature. While the recorded cases were mostly Asian ethnic patients, the course of their illness – including survival – was almost strikingly similar (and unfavorable).

Keywords:

gastric adenocarcinoma – chylothorax – bilateral pleural effusion

Zdroje

1. Drake RL, Vogl W, Mitchell AWM, et al. Gray‘s anatomy for students. Philadelphia: Elsevier/Churchill Livingstone 2005. ISBN 9780323611046.

2. Kašák V, Koblížek V, et al. Naléhavé stavy v pneumologii. 2. rozš. vyd. Praha: Maxdorf; 2009. ISBN 9788073451851.

3. Wu J, Lv L, Zhou K, et al. Chylothorax and lymphedema as the initial manifestations of gastric carcinoma: A case report and review of the literature. Oncol Lett 2016; 11(4): 2835–2838.

4. Devaraj U, Ramachandran P, Correa M, et al. Chylothorax in gastric adenocarcinoma: A case report and systemic review of the English literature. Lung India 2014; 31(1): 47–53.

5. Nagano N, Suzuki M, Tamura, et al. Refractory chylothorax and lymphedema caused by advanced gastric cancer. Intern Med 2019; 58: 3143–3148.

6. Yoshizawa K, Sasaki Y, Abe Y, et al. Chylothorax in a patient with advanced gastric cancer and mediastinal lymph node metastasis causing thoracic duct obstruction. Nihon Shokakibyo Gakkai Zasshi 2013; 110(11): 1943–1949.

7. Majoor CJ, Aliredjo RP, Dekhuijzen PN, et al. A rare cause of chylothorax and lymphedema. J Thorac Oncol 2007; 2: 247–248.