REFRACTORY CHYLOTHORAX SECONDARY TO WALDENSTROM MACROGLOBULINEMIA

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: A chylothorax is defined by the presence chyle within pleural cavity. Chylothoraces can be observed as a complication malignancy; however, Waldenstrom Macroglobulinemia (WM) has rarely been described potential cause. We present case refractory secondary to WM presenting periaortic mass, which eventually required thoracic duct embolization (TDE). CASE PRESENTATION: 76-year-old male former heavy smoker underwent low-dose chest CT that showed large right-sided effusion with suggestion subcarinal lymphadenopathy. The patient thoracentesis, and fluid appeared milky-orange (Figure 1) triglyceride concentration 410 mg/dL, diagnostic chylothorax. Contrast revealed soft tissue mass encasing descending aorta 2). Tissue sampling via endobronchial ultrasound (EBUS) demonstrated monomorphic population small lymphocytes expressing CD19, CD20, CD22, while being negative for CD5 CD10. Additional oncological evaluation including detection MYD88 L265P mutation led diagnosis WM. was started on combination chemoimmunotherapy had notable tumor response; he continued require high-volume therapeutic thoracentesis (2.5 liters per week). referred interventional radiology successful TDE without complications. Within weeks embolization, patient's milky decreased significantly in amount transitioned serosanguinous appearance 60 mg/dL. significant dyspnea relief frequency leading an improved quality-of-life. DISCUSSION: Lymphoma most common malignancy-associated cause literature, especially setting mass. Malignancy-associated chylothoraces commonly improve chemotherapy; this after months effective chemotherapy. Pedal lymphangiography identified lymphatic leak chest, successfully performed CONCLUSIONS: In patients non-traumatic chylothorax, malignancy should high differential diagnosis. Refractory serious decrement quality-of-life due chronic dyspnea, malnutrition, recurrent procedures. Early referral considered physicians REFERENCE #1: Rudrappa M, Paul M. Chylothorax. In: StatPearls. Treasure Island: StatPearls Publishing; 2021 Jan. #2: Otoupalova E, Meka SG, Dogra S, Dalal B. Recurrent chylothorax: clinical mystery. BMJ Rep. 2017;2017:bcr2017220750. Published 2017 Oct 6. doi:10.1136/bcr-2017-220750 DISCLOSURES: No relevant relationships Ali Bukhari, source=Web Response Matthew Koroscil, Nathan Mullen,