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An Unusual Cause of Transudative Lymphocytic Pleural Effusion
Disorders of the Pleura SESSION TITLE: Pleural Effusions SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM
An Unusual Cause of Transudative Lymphocytic Pleural Effusion Katelyn Krivchenia* Patrick Warren Tiffany Turner and Brian Becknell Nationwide Children’s Hospital, Columbus, OH
DISORDERS OF THE PLEURA
INTRODUCTION: Lymphocytic pleural effusions are usually caused by malignancy or tuberculosis (TB) in adults, and are only rarely reported in children. CASE PRESENTATION: We present a term male infant hospitalized at 3 months with a large right-sided pleural effusion associated with adenovirus infection. Fluid rapidly reaccumulated after thoracentesis necessitating chest tube placement. Fluid analysis revealed a transudative and lymphocytic effusion. A renal ultrasound demonstrated enlarged, dysplastic appearing kidneys with multiple microcysts. The chest tube was removed as the effusion resolved and the child was discharged home. Over the next year, he was admitted 3 times for recurrent pulmonary effusions requiring drainage. Analysis consistently demonstrated lymphocytic and transudative fluid. Further testing included negative PPD, normal echocardiogram, pleural fluid TB NAAT, normal T&B lymphocytes, low pleural cholesterol and triglycerides. He was started on diuretic therapy, though required readmission and placement of a tunneled chest tube for frequent drainage. Diuretics were discontinued, and losartan was started due to the presence of macroalbuminuria and hypertension. His pleural output fell dramatically after losartan initiation, and his drain was removed. Both MR and conventional lymphangiography were performed and revealed dilated ectatic retroperitoneal and mediastinal lymphatic channels. MR imaging also confirmed the full extent of renal involvement, with better elucidation of cystic renal dysplasia as well as revealing bilateral perinephric fluid collections. DISCUSSION: Based on imaging and clinical presentation, the diagnosis of Central Conducting Lymphatic Anomaly with extensive renal involvement was made. Such lymphatic malformations are rare, and associated pleural effusions are typically exudative and chylous. CONCLUSIONS: Our case demonstrates that this disease process may present with lymphatic and transudative pleural effusions. The marked reduction in pleural fluid output associated with losartan is highly intriguing and merits further investigation. Reference #1: Goldblum JR, Folpe AL, Weiss SW. (2014) Tumors and malformations of lymphatic vessls. In Weiss (Ed.) Enzinger and Weiss’s Soft Tissue Tumors (743-748). Philadelphia, PA:Elsevier Reference #2: Ozeki M, Fujino A, Matsuoka K, Nosaka S, Kuroda T, Fukao T. Clinical features and prognosis of gneralized lymphatic anomaly, kaposiform lymphangiomatosis, and gorham-stout disease. Pediatr Blood Cancer 2016;63:832-838 DISCLOSURE: The following authors have nothing to disclose: Katelyn Krivchenia, Patrick Warren, Tiffany Turner, Brian Becknell No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.559
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
530A
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152#4S CHEST OCTOBER 2017
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An Unusual Cause of Transudative Lymphocytic Pleural Effusion Katelyn Krivchenia* Patrick Warren Tiffany Turner and Brian Becknell Nationwide Children’s Hospital, Columbus, OH
DISORDERS OF THE PLEURA
INTRODUCTION: Lymphocytic pleural effusions are usually caused by malignancy or tuberculosis (TB) in adults, and are only rarely reported in children. CASE PRESENTATION: We present a term male infant hospitalized at 3 months with a large right-sided pleural effusion associated with adenovirus infection. Fluid rapidly reaccumulated after thoracentesis necessitating chest tube placement. Fluid analysis revealed a transudative and lymphocytic effusion. A renal ultrasound demonstrated enlarged, dysplastic appearing kidneys with multiple microcysts. The chest tube was removed as the effusion resolved and the child was discharged home. Over the next year, he was admitted 3 times for recurrent pulmonary effusions requiring drainage. Analysis consistently demonstrated lymphocytic and transudative fluid. Further testing included negative PPD, normal echocardiogram, pleural fluid TB NAAT, normal T&B lymphocytes, low pleural cholesterol and triglycerides. He was started on diuretic therapy, though required readmission and placement of a tunneled chest tube for frequent drainage. Diuretics were discontinued, and losartan was started due to the presence of macroalbuminuria and hypertension. His pleural output fell dramatically after losartan initiation, and his drain was removed. Both MR and conventional lymphangiography were performed and revealed dilated ectatic retroperitoneal and mediastinal lymphatic channels. MR imaging also confirmed the full extent of renal involvement, with better elucidation of cystic renal dysplasia as well as revealing bilateral perinephric fluid collections. DISCUSSION: Based on imaging and clinical presentation, the diagnosis of Central Conducting Lymphatic Anomaly with extensive renal involvement was made. Such lymphatic malformations are rare, and associated pleural effusions are typically exudative and chylous. CONCLUSIONS: Our case demonstrates that this disease process may present with lymphatic and transudative pleural effusions. The marked reduction in pleural fluid output associated with losartan is highly intriguing and merits further investigation. Reference #1: Goldblum JR, Folpe AL, Weiss SW. (2014) Tumors and malformations of lymphatic vessls. In Weiss (Ed.) Enzinger and Weiss’s Soft Tissue Tumors (743-748). Philadelphia, PA:Elsevier Reference #2: Ozeki M, Fujino A, Matsuoka K, Nosaka S, Kuroda T, Fukao T. Clinical features and prognosis of gneralized lymphatic anomaly, kaposiform lymphangiomatosis, and gorham-stout disease. Pediatr Blood Cancer 2016;63:832-838 DISCLOSURE: The following authors have nothing to disclose: Katelyn Krivchenia, Patrick Warren, Tiffany Turner, Brian Becknell No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.559
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
530A
[
152#4S CHEST OCTOBER 2017
]