View Abstract

A3233 - Recurrent Pleural Effusion 39 Years After Radiation Therapy
Author Block: V. Pathak, J. Wininger; WakeMed Health and Hospitals, Raleigh, NC, United States.
Introduction: Pulmonary and cardiovascular toxicities are known associated complications in adult patients that have survived childhood cancer who received radiation therapy (RT) in the past. This case report describes the rare occurrence of recurrent bilateral pleural effusions in a 51-year-old female with a history of nodular sclerosising Non-Hodgkin Lymphoma (NHL), in remission, 39 years after completion of RT to the neck and thorax. Description: A 51-year-old female with a history of NHL in remission s/p extensive RT in 1977, osteoporosis, hypothyroidism, atypical lymphoid infiltrative skin lesions, and a history of tobacco abuse presented to the emergency department in 2016 with a chief complaint of being short of breath. At that time she was found to have a large pericardial effusion with tamponade as well as bilateral pleural effusions. Multiple transthoracic echocardiograms showed normal left ventricular function. Throughout the course of her treatment over the next year and a half she required multiple procedures including pericardiocentesis due to recurrent tamponade physiology and bilateral thoracenteses to manage recurrent pleural effusions. Her pericardial fluid analyses did not reveal microbes or malignancy. Pleural fluid analyses were typically transudative and lymphocyte predominant. Multiple medical cytology evaluations of her pleural fluid were negative as were her pericardial fluid analyses. Flow cytometry was also negative. Medical pleuroscopy with pleural biopsy showed fibrotic tissue with acute and chronic inflammatory changes. Rheumatologic studies including: Sjogren's anti-SS-A and SS-B, Antinuclear ABS, Anti DNA DS, and RF were found to be negative. Discussion: Cardiovascular and pulmonary toxicities are associated risks after RT. Radiation pneumonitis can present early or late but usually occur in the first weeks to 12 months after RT. Bilateral pleural effusions have been noted to occur up to 20 years after radiation therapy. Cardiac toxicities due to RT can have a prolonged latent period of 10 to 15 years. To our knowledge, this is the first case found in the literature describing recurrent pericardial and bilateral pleural effusions almost 40 years post RT.