Thirty-Nine Years Later: A Case Report and Literature Review of Delayed Pleural and Pericardial Effusions After Chest Radiotherapy for Non-Hodgkin Lymphoma

Abstract

Radiation therapy (RT) is a common treatment for non-Hodgkin lymphoma (NHL) but can lead to long-term pulmonary and cardiovascular complications. Delayed radiotherapy-related pleural effusion (DRPE) and pericardial effusion are rare sequelae, with few cases reported. This case highlights recurrent pleural and pericardial effusions nearly 40 years after chest RT, underscoring the need for ongoing surveillance in cancer survivors. A 51-year-old female with a history of nodular sclerosing NHL in remission after RT in 1977 presented in 2016 with recurrent bilateral pleural and pericardial effusions. Despite multiple interventions, including pericardiocentesis, thoracenteses, and pleural catheter placement, her effusions persisted. An extensive workup ruled out malignancy, infection, and autoimmune causes, ultimately attributing the effusions to radiation-induced lung injury. Despite ongoing management, she was discharged to hospice care. DRPE is a diagnostic challenge due to its delayed onset, sometimes appearing decades after RT. It can present with variable pleural fluid characteristics. Radiation-induced lung injury is a known complication of thoracic RT, with risk factors including radiation dose and pre-existing pulmonary conditions. Management is symptomatic, with treatments such as NSAIDs, corticosteroids, diuretics, and pleural drainage, though outcomes vary. In this case, pleural catheter placement offered temporary relief, but recurrent effusions led to hospice care. This case highlights the need for long-term monitoring in survivors of chest RT, as delayed pulmonary and cardiovascular toxicities can arise decades later. Given the rarity of DRPE and the lack of standardized treatment, further research into protective strategies and early interventions for radiation-induced lung injury is essential to improve cancer survivors' quality of life.

Keywords: delayed radiotherapy-related pleural effusions; non-hodgkin lymphoma; radiation-induced lung injury; radiation-induced pleural effusions; radiotherapy related pericardial effusion.

Figure 1. CT showing complex large loculated pleural effusion in the right side (arrow)

CT: computed tomography