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A6703 - Chylothorax Due to Esophageal Duplication Cyst: Case Report
Author Block: L. J. Arroyo-Hernandez1, S. Rodriguez-Llamazares1, H. Rodriguez-Bautista1, R. Carriles-Heredia1, M. Salazar Lezama2; 1Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico, 2Instituto Nacional de Enfermedades Respiratorias, Mexico D.F., Mexico.
BACKGROUND: Chylothorax is a rare pathology with unknown incidence that usually requires specialized pulmonary evaluation to be diagnosed. Thus, most data regarding this disease comes from case reports or case series. Pathophysiology usually implies a thoracic duct rupture due to malignancy or trauma. CASE REPORT: A previously healthy 42 year old woman with a smoking history of 3 pack years suspended 11 years earlier, arrives to her Regional Hospital due to mMRC2 dyspnea and right pleuritic pain. Initial radiographic evaluation showed right pleural effusion which required drainage through thoracentesis. 2500cc of purulent fluid was obtained; no further testing was performed. After a failed chest tube placement attempt, she was referred to our center to receive specialized management. DIAGNOSTIC APPROACH: Upon arrival, a new thoracenthesis revealed a turbid orange effusion which additional study revealed it to be a lymphocytic exudate with 291mg/dl of triglycerides and 30mg/dl of cholesterol compatible with chylothorax. After drainage with an ultrasound guided thoracotomy tube placement, a contrast enhanced thoracic CT scan showed a cystic mass of 123 x 84 x 125mm with a 3mm wall within the posterior mediastinum localized next to both right cardiac cavities while compressing the superior vena cava. Cystectomy through thoracotomy revealed an esophageal duplication cyst. TREATMENT: A second surgical intervention performed a successful ligature of the thoracic conduct. CONCLUSION: Chylothorax is a rare pathology with unknown incidence that usually requires specialized pulmonary evaluation to be diagnosed. Thus, most data regarding this disease comes from case reports or case series. Furthermore, esophageal duplication cyst’s prevalence is 0.0122% with only 7% diagnosed during adult life. The latter cases are usually detected through compression of mediastinal structures such as dyspnea due to tracheal obstruction or dysphagia secondary to esophageal compression. There are no cases reported so far of these type of cysts that present themselves as chylothorax. However, because of the epidemiological traits of both these diseases, it is unknown if this case is unique because more cases are never diagnosed or because of rare occurrence.