Page 5 / January 07
The only thing against the diagnosis of chylothorax is the low lymphocyte content (see definition of chylothorax below). A possible explanation for this finding is the severe lymphopenia this patient is suffering, probably related to his underlying leukemia and/or it's chemotherapy.
A computerized tomography scan of the chest showed a left pleural effusion, without features of loculation. There was no lymphadenopathy. Intravenous contrast showed patent vessels.
By the end of the first week of management with the fat restricted diet and antibiotics, the chest drain out-put became less than 20ml per day (see diagram below of chest drain out-put). (see graph 1)
The chest drain was clamped on the 7th day and subsequently removed on the 8th with no change in the clinical picture and a clear chest X-ray. Antibiotics were also discontinued after the result of a negative bacterial culture. A repeated chest x-ray after 2 weeks was normal.
Left chylothorax in a 5 year old boy known to have Down syndrome, acute lymphoblastic leukemia and mild intermittent asthma.
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ANSWER:
The only thing against the diagnosis of chylothorax is the low lymphocyte content (see definition of chylothorax below). A possible explanation for this finding is the severe lymphopenia this patient is suffering, probably related to his underlying leukemia and/or it's chemotherapy.
Hospital course:
Intravenous antibiotics in the form of Pipracillin/tazobactam & Gentamicin were started. He showed immediate improvement in respiratory distress after the pleurocentesis, with resolution of fever within 24 hours of treatment. A fat restricted diet was initiated.A computerized tomography scan of the chest showed a left pleural effusion, without features of loculation. There was no lymphadenopathy. Intravenous contrast showed patent vessels.
By the end of the first week of management with the fat restricted diet and antibiotics, the chest drain out-put became less than 20ml per day (see diagram below of chest drain out-put). (see graph 1)
The chest drain was clamped on the 7th day and subsequently removed on the 8th with no change in the clinical picture and a clear chest X-ray. Antibiotics were also discontinued after the result of a negative bacterial culture. A repeated chest x-ray after 2 weeks was normal.
Final diagnosis:
Left chylothorax in a 5 year old boy known to have Down syndrome, acute lymphoblastic leukemia and mild intermittent asthma.
Do you have possible explanation for this?
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