Abstract

Authors:

Dr Cherukumalli Navya, Dr Yuvarajan.S, Dr Praveen.R, Dr Antonious Maria Selvam, Dr prathaban.K

Institute: Sri Manakula Vinayagar Medical College And Hospital ,Madagadipet.

Introduction:

Chylothorax is defined by the presence of chyle in the pleural space and is usually the result of disruption or obstruction of the thoracic duct or one of its tributaries. Chyloptysis is expectoration of milky white sputum rich in chyle which is a rare manifestation of chylous disorders.

Case Presentation

42 year old female had presented with a history of breathlessness since 6 months associated with cough and milky white sputum. Chest x-ray revealed bilateral Costophrenic angle blunting and diagnostic thoracocentesis showed milky fluid. Lymphangiography showed active extravasation of lipoidal at D7 into the bilateral pleural cavity. An enlarged right cervical lymphnode biopsy was suggestive of metastatic squamous cell carcinoma and the patient was initiated with chemotherapy.

Conclusion

Chyloptysis can be caused by high peribronchial lymphatic pressure if the thoracic duct is obstructed above the mid mediastinal level or may be due to incompetence of the lymphatic valves. Mediastinal tumors, particularly lymphomas, are the main causes of mechanical obstruction of the thoracic duct. Treatment for chylothorax is focused on treating the primary cause and reducing the chyle formation. In most patients, symptoms can be relieved by eliminating the underlying cause or bypassing the thoracic duct.

Chyloptysis is a rare and easy to misdiagnose entity but proper clinical assessment and investigations aid in early diagnosis and treatment of the etiology.