Recurrent Chylothorax as a Consequence of Esophageal Stent

First Author(s)

• 

  Daisy Young

  n/a
  Elmhurst, NY

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• 

  Elnaz Mahbub, DO,

  Resident Physician
  Stony Brook Southampton Hospital
  Southampton, NY

  Disclosure information not submitted.
• 

  Andrew Grees

  Stony Brook Southampton Hospital
  Hampton Bays, NY

  Disclosure information not submitted.
• 

  Garry Lachhar, MD

  Resident Physician
  Stony Brook Southampton Hospital
  Southampton, NY

  Disclosure information not submitted.
• AB

  Ashley Bray, MD

  Dr. Ashley Bray
  Elmhurst Hospital Center, United States

  Disclosure information not submitted.
• SK

  Sowmya Kalava, MD

  Dr. Sowmya Kalava
  Elmhurst Hospital Center, United States

  Disclosure information not submitted.
• MH

  Maryam Hajiabbasi, MD

  Dr. Maryam Hajiabbasi
  Elmhurst Hospital Center, United States

  Disclosure information not submitted.
• KD

  Kenneth D'Souza, MD

  Dr. Kenneth D'Souza
  Elmhurst Hospital Center, United States

  Disclosure information not submitted.
• MW

  Martin Warshawsky, MD

  Dr. Martin Warshawsky
  Elmhurst Hospital Center, United States

  Disclosure information not submitted.
• MP

  Muhammad Perwaiz, MD

  Dr. Muhammad Perwaiz
  Elmhurst Hospital Center, United States

  Disclosure information not submitted.

Title: Recurrent Chylothorax as a Consequence of Esophageal Stent

Introduction: Postoperative chylothorax accounts for >50% of all cases of chylothorax, of which esophagectomy has a 5-10% overall risk.1 However, the incidence of chylothorax complicated by post-esophageal stenting is not reported. We present a case of recurrent right-sided chylothorax after esophageal stent placement.

Description: A 40-year-old female with metastatic breast cancer presented with progressive dyspnea over a month. She was previously hospitalized in April 2021 for dysphagia. Computed Tomography (CT) chest reported a moderate right pleural effusion and posterior mediastinal mass for which an esophageal stent was placed. In the subsequent three days, she had increasing oxygen requirements with imaging that demonstrated an interval increase in the right pleural effusion and a new, small left pleural effusion. Thoracentesis was performed revealing a non-malignant, lymphocyte-predominant exudate. She presented three months later with tachycardia and hypoxemia. CT chest reported a large right pleural effusion with near-complete compression of the right lung, and large left pleural effusion. Bedside 14-Fr catheter was placed, draining two liters of a cloudy, non-malignant, lymphocyte-predominant chylothorax with fluid triglyceride level of 152 mg/dL. During her admission, the esophageal stent was retracted proximally. The subsequent effusion was transudative, with a triglyceride level of 32 mg/dL.

Discussion: Chylothorax is defined as a pleural fluid triglyceride concentration >110 mg/dL in a lymphocyte-predominant exudative effusion2. Our patient’s initial pleural fluid studies was likely confounded by the presence of existing pleural effusion before the procedure. After the existing fluid was drained and allowed to reaccumulate, repeat studies demonstrated a chylothorax. Detailed review of the CT chest revealed an impingement of the thoracic duct by the esophageal stent at the level of T7, with the distal portion of the duct obliterated by the stent as it travels from T7 to T4. In general, thoracic duct injury or obstruction below T5 (where it crosses the mediastinum from right to left) results in a right–sided pleural effusion, while above T5 leads to a left-sided effusion3. Interestingly, upon manipulation of the esophageal stent proximally, the chylothorax transitioned to a transudative fluid.