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Case Reports
. 2022 Jul 1;61(13):2039-2043.
doi: 10.2169/internalmedicine.8293-21. Epub 2021 Nov 20.

Successful Treatment of Chylothorax and Chylopericardium by Radiotherapy in Lung Cancer

Ryota Shintani  1   2 , Akimasa Sekine  2 , Kota Murohashi  2 , Ryota Otoshi  2 , Takeo Kasuya  3 , Tsuneyuki Oda  2 , Tomohisa Baba  2 , Shigeru Komatsu  2 , Takashi Ogura  2 , Yoshikazu Inoue  4
Affiliations
Case Reports

Successful Treatment of Chylothorax and Chylopericardium by Radiotherapy in Lung Cancer

Ryota Shintani et al. Intern Med. .

Abstract

A 58-year-old man was diagnosed with stage IVB lung adenocarcinoma in the right upper lobe and underwent systemic chemotherapy. Seven months after the diagnosis, large left pleural and pericardial effusion was detected. The patient developed both chylothorax and chylopericardium following superior vena cava (SVC) obstruction with mediastinal lymphadenopathy caused by lung carcinoma. Since conservative treatment of the chyle leakage was ineffective, we administered radiotherapy to treat the SVC obstruction and mediastinal lymphadenopathy. After radiotherapy, the chylothorax and chylopericardium gradually resolved, and no further chyle leaks were identified on follow-up computed tomography. This case indicates that radiotherapy can be used to ameliorate lung cancer-related chylothorax and chylopericardium.

Keywords: chylopericardium; chylothorax; lung cancer; radiotherapy.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
(A) Admission chest X-ray showing a mediastinal mass, left pleural effusion and enlarged cardiac silhouette. (B, C) Contrast-enhanced computed tomography revealed superior vena cava obstruction by a large lung mass with mediastinal invasion, left pleural effusion and marked pericardial effusion.
Figure 2.
Figure 2.
(A) Chylous pleural fluid with a milky appearance. (B) Chylous pericardial fluid with a milky appearance.
Figure 3.
Figure 3.
Radiotherapy plan showing the isodose line on axial, sagittal, and coronal images. The clinical target volume included the tumor in the right upper lobe and mediastinal lymph node.
Figure 4.
Figure 4.
(A) Chest X-ray at the start of radiotherapy, on day 15, showing the right upper and left lower field shadow, left pleural effusion and enlarged cardiac silhouette. (B) At the end of radiotherapy, on day 35, bilateral pleural effusion and enlarged cardiac silhouette are still present. (C) Chest X-ray, two months after radiotherapy, showing a marked improvement in chylothorax and chylopericardium.
Figure 5.
Figure 5.
(A, B) Contrast-enhanced CT performed two months after radiotherapy revealed shrinking of the tumor in the right upper lobe and mediastinal lymph node. SVC obstruction and small amounts of pericardial and pleural fluids remained.
See this image and copyright information in PMC

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