A Discussion of Spontaneous Chylothorax in Senile Patients Misdiagnosed as Chronic Heart Failure

FAN Guang-de; MEI Zhou-fang; HUANG Qi-hui; QIAN Ling; DU Yong; SHI Jing-dong; JIE Zhi-jun

doi:10.3969/j.issn.1002-3429.2015.07.003

Abstract：Objective To analyze the cause of misdiagnosis of spontaneous chylothorax to improve treatment of this disease. Methods A case of spontaneous chylothorax of our hospital was retrospectively analyzed, with a review of literature. Results Upon admission, the 81-year-old female patient, who had been diagnosed as chronic heart failure and pleural effu-sion in a local hospital, complained of dyspnea on exertion and foot edema for more than 20 days. After taking diuretics and cardiotonic drugs, her condition became worse, and then she was transferred to our hospital. The heart structure and function were not obviously abnormal on echocardiography. The chest CT scan showed right pleural effusion, with incomplete expansion in the lower lobe of the right lung. The pleural effusion was found to be chyliform after thoracentesis. The examination of pleu-ral effusion showed that the bacterial culture was negative and the dyeing with Sudan Ⅲ was positive. After other relevant dis-eases were excluded, the spontaneous chylothorax was diagnosed. Therefore, the patient was treated with pleural closure for 5 times using lidocaine 0. 2 g, lentinan 3 mg, dexamethasone 5 mg and normal saline 20 ml. The chest CT scan showed that the pleural effusion subsided. During eight months of follow-up, there was no relapse of chylothorax. Conclusion For patients with pleural effusion, particularly associated with a variety of complications, a diagnostic thoracentesis should be performed. The examination of hydrothorax is necessary for confirming the cause of the disease. The dyeing with Sudan Ⅲ for pleural effu-sion is helpful to identify the real chylothorax.