Transudative chylothorax and frailty: a diagnostic and therapeutic challenge

Abstract

Transudative chylothoraces are a rare entity and their management in the presence of multiorgan dysfunction and frailty is complex. A woman in her 90s was investigated during acute hospital admission and found unexpectedly to have a transudative chylothorax secondary to cryptogenic cirrhosis. Not all chylothoraces have the classically described milky appearances and a high index of suspicion is vital in determining appropriate investigation and management. Our patient required repeated thoracocentesis and subsequently chose to be discharged from hospital with comfort care. Management of non-malignant pleural effusions can be challenging. Case reports surrounding the management of transudative chylothoraces in particular are scarce. Establishing patient priorities and openly explaining the uncertainty regarding prognosis and potential therapeutic options is paramount in this complex and changing field.

Keywords: Cirrhosis; Respiratory medicine.

Figure 1

Chest X-ray. Anterior-posterior view.

Figure 2

CT scan shoring pleural effusion.