Medicina Pulmonar e Respiratória

Chylothorax in a Patient with Pulmonary Aspergillosis and Chronic Renal Disease in Hemodialysis

Abstract

Jorge I Miranda, Lenín O Guevara Gutiérrez, Aracely A Siu Blanco, Carlos J Quant Durán, Sumaya E Moreira López and Alfredo Celedón Lacayo

Chylothorax is the accumulation of lymphatic fluid (chyle) in the pleural space, as a result of obstruction, injury or leakage of the thoracic duct or one of its tributaries. The frequency of causes of chylothorax depends on the type of hospital and the population served but there are few reports of this complication in people with end- stage renal disease and the outcomes with different interventions. We report the case of a 35-years-old man from a low-altitude agricultural community in northwest Nicaragua, diagnosed with end-stage chronic kidney disease (CKD) of nontraditional etiology three months before admission who developed chylothorax after dysfunction of central venous catheter (CVC) at the right internal jugular vein for hemodialysis. After multidisciplinary approach, we found no cause of the chylothorax other than pulmonary Aspergillosis with mediastinal adenopathy and possible external pressure to the thoracic duct as a mechanism similar described in pulmonary tuberculosis, sarcoidosis and histoplasmosis. Chylothorax resolved with the treatment for aspergillosis and performance of lymphangiography with lipiodol after conservative treatment for chylothorax failed and before we continued to embolization of the thoracic duct, which allowed us to performance pleurodesis with iodine without complications. We reviewed the etiologies of chylothorax in patients with end-stage renal disease in hemodialysis reported so far and found no reports of aspergillosis as a cause of chylothorax.