Event Title

Chylothorax at 'Signet ring'(gastrointestinal) Adenocarcinoma - solving with Talc 'slurry' pleurodhesis. Case report

Session

Medicine and Nursing

Description

Patient, 57 years old, male, with right pleural effusion. Condition after ambulantory pleural puncture evacuation of 2700 ml fibrinous serous fluid (turbid, purulent?).

State after lymph node biopsy in the left inguinal region, 10 months ago (Tirana,ALbania);with dg. Adenocarcinoma Signet ring cell; Metastasis from the gastrointestinal tract (Stone-shaped cell in the ring);

Ambulantory treated, week after, he is hospitalized in Thoracic Surgery Clinic and drained 2 L of pleural fluid (turbid, pus?) from the right hemithorax.

At the Thoracic Clinic it is treated with antibiotics , but meanwhile the pleural fluid takes on an opalescent color (yellowish) which is suspect on lymph leakage. There is also crural (see photo) and corporal lymphedema (abdominal and back);

After reviewing the literature, we learn that there are cases of Adenocarcinoma signet ring of the gastrointestinal tract (90% of the stomach) (with stone-shaped cells in the ring) in the presence of lymph flow (chyle) in the thorax (pleura): chylothorax;

Laboratory: Hypoalbuminemia-->albumine:29.3 --> 27.3 ---> 28.6 g/L; Albumin 20% is added to the therapy 2 times a day as well. After the analysis of pleural fluid (17 days after hospitalization ) Glucose 5.82mmol/L; albumine: 13.9 g / L; LDH: 199 U / L and from clinical point of view (crural / corporal lymphedema) it's decided to start with treatment with low fat diet, rich in protein and with Octreotide acetate Injection (Sandostatin * Novartis with a dose of 100 micrograms / 8 h subcutaneously . Four days later, 250 ml of chyle per day is produced .We continue with broad-spectrum antibiotherapy and Octreotide , Albumin and low-fat diet.Hematologic findings: RBC: 4.47 x 109/; Le: 7.3 x 109/; Hb: 139g/L; Hct: 45; Biochemistry: glucosae: 4.73mmol/L; cholesterol: 3.71mmol/L ; Creatinine: 86.5mikromol/L; Total bilirubine 4.5mikromol/L; Direct bilirubine: 1.25mikromol/L; ALT 14 U/L; AST 18 U/L; Albumine: 28.6 g / L; Total protein 47.8 g / L; CRP 10.0 mg / L; So, we indicate pleurodesis (it's three week after admitting on Clinic) with 'Talc slurry’ solution (4 g) "Steritalc" + 5 amp Lidocaine 2% +100 ml saline Na Cl 0.9%. The next day there is no pleural fluid leakage. The drain is removed 4 days later. The patient has corporal swelling; oxymetry: 91%, Pp: 90/min;

Five month later there is pleural effusion of the opposite side which is treated with evacuation punctures of pleural fluid. Patients in preterminal and terminal state exit.

Keywords:

Chylothorax, Adenocarcinoma(signet ring); Pleurodhesis

Proceedings Editor

Edmond Hajrizi

ISBN

978-9951-550-47-5

Location

UBT Kampus, Lipjan

Start Date

30-10-2021 12:00 AM

End Date

30-10-2021 12:00 AM

DOI

10.33107/ubt-ic.2021.192

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Oct 30th, 12:00 AM Oct 30th, 12:00 AM

Chylothorax at 'Signet ring'(gastrointestinal) Adenocarcinoma - solving with Talc 'slurry' pleurodhesis. Case report

UBT Kampus, Lipjan

Patient, 57 years old, male, with right pleural effusion. Condition after ambulantory pleural puncture evacuation of 2700 ml fibrinous serous fluid (turbid, purulent?).

State after lymph node biopsy in the left inguinal region, 10 months ago (Tirana,ALbania);with dg. Adenocarcinoma Signet ring cell; Metastasis from the gastrointestinal tract (Stone-shaped cell in the ring);

Ambulantory treated, week after, he is hospitalized in Thoracic Surgery Clinic and drained 2 L of pleural fluid (turbid, pus?) from the right hemithorax.

At the Thoracic Clinic it is treated with antibiotics , but meanwhile the pleural fluid takes on an opalescent color (yellowish) which is suspect on lymph leakage. There is also crural (see photo) and corporal lymphedema (abdominal and back);

After reviewing the literature, we learn that there are cases of Adenocarcinoma signet ring of the gastrointestinal tract (90% of the stomach) (with stone-shaped cells in the ring) in the presence of lymph flow (chyle) in the thorax (pleura): chylothorax;

Laboratory: Hypoalbuminemia-->albumine:29.3 --> 27.3 ---> 28.6 g/L; Albumin 20% is added to the therapy 2 times a day as well. After the analysis of pleural fluid (17 days after hospitalization ) Glucose 5.82mmol/L; albumine: 13.9 g / L; LDH: 199 U / L and from clinical point of view (crural / corporal lymphedema) it's decided to start with treatment with low fat diet, rich in protein and with Octreotide acetate Injection (Sandostatin * Novartis with a dose of 100 micrograms / 8 h subcutaneously . Four days later, 250 ml of chyle per day is produced .We continue with broad-spectrum antibiotherapy and Octreotide , Albumin and low-fat diet.Hematologic findings: RBC: 4.47 x 109/; Le: 7.3 x 109/; Hb: 139g/L; Hct: 45; Biochemistry: glucosae: 4.73mmol/L; cholesterol: 3.71mmol/L ; Creatinine: 86.5mikromol/L; Total bilirubine 4.5mikromol/L; Direct bilirubine: 1.25mikromol/L; ALT 14 U/L; AST 18 U/L; Albumine: 28.6 g / L; Total protein 47.8 g / L; CRP 10.0 mg / L; So, we indicate pleurodesis (it's three week after admitting on Clinic) with 'Talc slurry’ solution (4 g) "Steritalc" + 5 amp Lidocaine 2% +100 ml saline Na Cl 0.9%. The next day there is no pleural fluid leakage. The drain is removed 4 days later. The patient has corporal swelling; oxymetry: 91%, Pp: 90/min;

Five month later there is pleural effusion of the opposite side which is treated with evacuation punctures of pleural fluid. Patients in preterminal and terminal state exit.