Ultrasound quantification of pleural effusion volume in supine position: comparison of three model formulae.

BACKGROUND: To investigate the accuracy of three model formulae for ultrasound quantification of pleural effusion (PE) volume in patients in supine position. METHODS: A prospective study including 100 patients with thoracentesis and drainage of PE was conducted. Three model formulae (single section model, two section model and multi-section model) were used to calculate the PE volume. The correlation and consistency analyses between calculated volumes derived from three models and actual PE volume were performed. RESULTS: PE volumes calculated by three models all showed significant linear correlations with actual PE volume in supine position (all p < 0.001). The reliability of multi-section model in predicting PE volume was significantly higher than that of single section model and slightly higher than that of two section model. When compared with actual drainage volume, the intra-class correlation coefficients (ICCs) of single section model, two section model and multi-section model were 0.72, 0.97 and 0.99, respectively. Significant consistency between calculated PE volumes by using two section model and multi-section model existed for full PE volume range (ICC 0.98). CONCLUSION: Based on the convenience and accuracy of ultrasound quantification of PE volume, two section model is recommended for pleural effusion assessment in routine clinic, though different model formulae can be selected according to clinical needs.

Re-expansion Pulmonary Edema (REPE) Following Thoracentesis: Is Large-Volume Thoracentesis Associated with Increased Incidence of REPE?

PURPOSE: To determine the safety and efficacy associated with drainage volumes greater than 1,500 mL in a single, unilateral thoracentesis without pleural manometry measurements. MATERIALS AND METHODS: This retrospective, single-institution study included 872 patients (18 years and older) who underwent ultrasound-guided thoracentesis. Patient and procedures data were collected including demographics, number of and laterality of thoracenteses, volume and consistency of fluid removed, and whether clinical or radiologic evidence of re-expansion pulmonary edema (REPE) developed within 24 h of thoracentesis. Fisher's exact test was used to test the significance of the relationship between volume of fluid removed and evidence of REPE. RESULTS: A total of 1376 thoracenteses were performed among the patients included in the study. The mean volume of fluid removed among all procedures was 901.1 mL (SD = 641.7 mL), with 194 (14.1%) procedures involving the removal of ≥ 1,500 mL of fluid. In total, six (0.7%) patients developed signs of REPE following thoracentesis, five of which were a first-time thoracentesis. No statistically significant difference in incidence of REPE was observed between those with ≥ 1,500 mL of fluid removed compared to those with < 1,500 mL of fluid removed (p-value = 0.599). CONCLUSIONS: Large-volume thoracentesis may safely improve patients' symptoms while preventing the need for repeat procedures.

Computed tomography attenuation in differential diagnosis of transudative and exudative pleural effusions.

OBJECTIVE: Pleural effusion is a common medical problem. It is important to decide whether the pleural fluid is a transudate or an exudate. This study aims to measure the attenuation values of pleural effusions on thorax computed tomography and to investigate the efficacy of this measurement in the diagnostic separation of transudates and exudates. MATERIALS AND METHODS: 380 cases who underwent thoracentesis and thorax computed tomography with pleural effusion were classified as exudates or transudates based on Light's criteria. Attenuation measurements in Hounsfield units were performed through the examination of thorax computed tomography images. RESULTS: 380 patients were enrolled (39 % women), the mean age was 69.9 ± 15.2 years. 125 (33 %) were transudates whereas 255 (67 %) were exudates. The attenuation values of exudates were significantly higher than transudates (15.1 ± 5.1 and 5.0 ± 3.4) (p < 0.001). When the attenuation cut-off was set at ≥ 10 HU, exudates were differentiated from transudates at high efficiency (sensitivity is 89.7 %, specificity is 94.4 %, PPV is 97 %, NPV is 81.9 %). When the cut-off value was accepted as < 6 HU, transudates were differentiated from exudates with 97.2 % specificity. CONCLUSION: The attenuation measurements of pleural fluids can be considered as an efficacious way of differentiating exudative and transudative pleural effusions.

Intrapleural nivolumab in cancer patients with pleural effusion.

ABSTRACT: We assessed the preliminary efficacy and toxicity of intrapleural instillation of nivolumab in patients with large pleural effusion. Patients with metastatic cancers who have a large volume of pleural effusion and required evacuation were eligible. Thoracentesis followed by nivolumab (40 mg, single intrapleural instillation) was performed. The primary endpoint was 3-month recurrence-free survival. A total of 13 patients were enrolled. The study was terminated after stage 1 as no efficacy was observed; 7 patients (54%) had a recurrence of pleural effusion at 3 months. Thirteen (100%) patients had no recurrence, dyspnea, or cough within 1 month, and the median time to recurrence was 1.9 months (95% confidence interval [CI], 1.35-2.5). No adverse events were identified. We concluded that a single intrapleural instillation of the nivolumab at 40 mg was ineffective and well-tolerated in cancer patients with pleural effusion.

Diagnosis and Treatment of Pleural Effusion. Recommendations of the Spanish Society of Pulmonology and Thoracic Surgery. Update 2022

Pleural effusion (PE) is a common yet complex disease that requires specialized, multidisciplinary management. Recent advances, novel diagnostic techniques, and innovative patient-centered therapeutic proposals have prompted an update of the current guidelines. This document provides recommendations and protocols based on a critical review of the literature on the epidemiology, etiology, diagnosis, prognosis, and new therapeutic options in PE, and addresses some cost-effectiveness issues related to the main types of PE. (AU)

Bula gigante secundaria a neumonía adquirida en la comunidad en niños / Giant Bulla Secondary to Community-Acquired Pneumonia in Children

Introducción: Los neumatoceles y las bulas pulmonares son lesiones que se observan en los niños casi siempre asociadas a neumonías infecciosas, aunque sus causas pueden ser diversas. La importancia clínica de estos procesos radica en el peligro de crecimiento progresivo, que puede comprometer las funciones respiratoria y cardiovascular. Objetivo: Describir las experiencias derivadas del proceso de diagnóstico por imágenes y del tratamiento invasivo de casos atendidos. Presentación de los casos: Desde finales de 2021 y durante un período de un año, se atendieron, en la unidad de cuidados intensivos pediátricos del Hospital Pediátrico Universitario de Cienfuegos, cinco niños con neumonías extensas, que desarrollaron bulas de gran tamaño varios días después del tratamiento antimicrobiano adecuado. Estas necesitaron drenaje y aspiración percutáneos debido a su magnitud y a la presencia de síntomas cardiovasculares. Conclusiones: Las bulas que aparecieron como complicación de la neumonía en el niño pueden presentarse con una frecuencia no despreciable, y hay que mantenerse atentos a su evolución, porque, a diferencia de los neumatoceles, pueden crecer progresivamente y comprometer las funciones respiratoria y cardiovascular. El drenaje percutáneo y aspiración continua por cinco días resultó un método seguro y eficaz para tratar estos procesos(AU)

Introduction: Pneumoatoceles and pulmonary bullae are lesions that are observed in children almost always associated with infectious pneumonia, although their causes may be diverse. The clinical importance of these processes lies in the danger of progressive growth, which can compromise respiratory and cardiovascular functions. Objective: To describe the experiences derived from the imaging process and the invasive treatment of treated cases. Presentation of the cases: Since the end of 2021 and for a period of one year, five children with extensive pneumonia were treated in the pediatric intensive care unit of the University Pediatric Hospital of Cienfuegos, who developed large bullae several days after appropriate antimicrobial treatment. The bullae required percutaneous drainage and aspiration due to their magnitude and the presence of cardiovascular symptoms. Conclusions: The bulla that appeared as a complication of pneumonia in the child can occur with a not negligible frequency, and it is necessary to be attentive to their evolution, because, unlike pneumoatoceles, can grow progressively and compromise respiratory and cardiovascular functions. Percutaneous drainage and continuous aspiration for five days was a safe and effective method to treat these processes(AU)

Neumotórax espontáneo / Spontaneous pneumothorax

Introducción: El neumotórax espontáneo es la causa más frecuente de ingreso urgente en los servicios de cirugía torácica. Objetivo: Caracterizar a pacientes ingresados con diagnóstico de neumotórax espontáneo. Métodos: Se realizó un estudio descriptivo de 93 pacientes con diagnóstico clínico y radiológico de neumotórax espontáneo, se establecieron las variables del estudio y se utilizaron frecuencias absolutas y porcentajes. Para la asociación de las variables se empleó el estadígrafo ji cuadrado con un nivel de confiabilidad del 95 por ciento. Resultados: Predominó el neumotórax espontáneo primario (65,5 por ciento), el sexo masculino fue el más afectado (80,6 por ciento), con mayor frecuencia en el hemitórax derecho (72,2 por ciento) y el tabaquismo como antecedente (83,9 por ciento). La pleurostomía mínima fue el tratamiento definitivo en el 72 por ciento de los pacientes. La complicación más frecuente después de la pleurostomía, fue la fuga persistente de aire. El tratamiento quirúrgico con pleurodesis mecánica, ofreció un 100 por ciento de efectividad. La mortalidad quirúrgica fue nula. Conclusiones: El neumotórax espontáneo predomina en el sexo masculino en una proporción de 4,2:1, en pacientes menores de 40 años de edad. El antecedente patológico personal que más se asocia es la enfermedad pulmonar obstructiva crónica. El síntoma predominante es el dolor torácico. El neumotórax espontáneo primario fue más frecuente y el hemitórax derecho el más afectado. El tabaquismo está presente como antecedente en ambos tipos de neumotórax espontáneo. La modalidad de tratamiento más utilizada es la pleurostomía mínima(AU)

Introduction: Spontaneous pneumothorax is the most frequent cause of urgent admission to thoracic surgery services. Objective: To characterize patients admitted with a diagnosis of spontaneous pneumothorax. Methods: A descriptive study of 93 patients with a clinical and radiological diagnosis of spontaneous pneumothorax was carried out, the study variables were established and absolute frequencies and percentages were used. For the association of the variables, the chi square statistic was used with a confidence level of 95 percent. Results: Primary spontaneous pneumothorax predominated (65.5 percent), the male sex was the most affected (80.6 percent), with greater frequency in the right hemithorax (72.2 percent) and smoking as the antecedent (83.9 percent). Minimal pleurostomy was the definitive treatment in 72 percent of the patients. The most frequent complication after pleurostomy was persistent air leak. Surgical treatment with mechanical pleurodesis offered 100 percent effectiveness. There was not surgical mortality. Conclusions: Spontaneous pneumothorax predominated in males in a ratio of 4.2: 1, in patients under 40 years of age. The most associated personal pathological history was chronic obstructive pulmonary disease. The predominant symptom was chest pain. Primary spontaneous pneumothorax was more frequent and the right hemithorax the most affected. Smoking was present as a history in both types of spontaneous pneumothorax. The most widely used treatment modality was minimal pleurostomy(AU)

Mantle Cell Lymphoma - a less frequent presentation

The clinical manifestations of non-Hodgkin's lymphomas (NHL) are unspecific and may vary with their location, growth rate or organs involved. Chylothorax consists of an accumulation of chyle in pleural space. galiLymphoproliferative diseases represent the main non-traumatic aetiology. The authors report the case of an 81-year-old woman admitted with right pleural effusion and lower limbs oedema, initially interpreted as decompensated heart failure. The thoracocentesis revealed a chylothorax and the aetiological study exposed a mantle cell lymphoma. The authors aim to alert to a less frequent presentation of NHL and remind that a low suspicion may delay the diagnosis

No disponible

Síndrome de pulmón encogido y derrame pleural como manifestación inicial de síndrome de Sjögren primario / Shrinking lung syndrome and pleural effusion as an initial manifestation of primary Sjögren's syndrome

No disponible

Pleuritis por Cryptococcus neoformans en paciente inmunocompetente / Cryptococcus neoformans pleuritis in an immunocompetent patient

No disponible

Toracocentesis en Atención Primaria / Thoracentesis in Primary Care

La toracocentesis es una prueba sencilla y con escasas complicaciones que aporta información relevante en el diagnóstico de un derrame pleural, a través de una correcta interpretación del análisis del líquido pleural. Una iniciativa interesante sería incorporar esta técnica a aquellos equipos de Atención Primaria que atienden a pacientes graves y complejos con dificultades para el desplazamiento a centros especializados distantes de sus domicilios. En este contexto, un buen conocimiento de las posibilidades diagnósticas que ofrece el análisis del líquido pleural podría ser de gran utilidad, en manos de personal bien entrenado, para establecer la etiología de un derrame pleural e iniciar, con la mayor celeridad posible, su tratamiento. Este artículo trata de contribuir a ello, trasmitiendo unas pautas de cómo una técnica sencilla puede aportar información relevante para conocer la etiología del derrame pleural y que podría implementarse en un determinado marco de Atención Primaria

Thoracentesis is a simple test with few complications that provides relevant information in the diagnosis of a pleural effusion, through a correct interpretation of the pleural fluid analysis. An interesting initiative would be to incorporate this technique by those Primary Care teams that treat serious and complex patients, with difficulties in moving to specialised centres far from their homes. In this context, a good knowledge of the diagnostic possibilities offered by the pleural fluid analysis could be very useful in the hands of well trained staff to establish the aetiology of a pleural effusion and be able to initiate, as quickly as possible, its treatment. This article aims to contribute to this, by suggesting guidelines on how a simple technique can provide relevant information in order to determine the aetiology of pleural effusion, and which could be implemented within a given Primary Care framework

Citopatología y bioquímica del líquido pleural reumatoideo. A propósito de un caso / Cytopathology and biochemistry of the rheumatoid pleural fluid. Presentation of a case

Entre las distintas complicaciones pleuropulmonares de la artritis reumatoide, la pleuresía reumatoidea es la más comúnmente observada, sucediendo hasta en el 5% de los pacientes afectos de artritis reumatoide. La mayoría de estos, corresponden a un subtipo compuesto fundamentalmente por varones de edad media con altos títulos de factor reumatoide, nódulos reumatoideos y HLA-B8 y Dw3. Si bien el derrame pleural reumatoideo se presenta generalmente como un exudado inespecífico, se han descrito características de laboratorio, que aunque infrecuentes, nos pueden ser de gran utilidad, en el diagnóstico del mismo

Among the various pleuropulmonary complications of rheumatoid arthritis, rheumatoid pleurisy is the most commonly observed1, occurring in up to 5% of patients with rheumatoid arthritis. The majority of these correspond to a subtype composed mainly of middle-aged men with high rheumatoid factor titres, rheumatoid nodules, and presence of HLA-B8 and Dw3. Although rheumatoid pleural effusion generally presents as a non-specific exudate, laboratory characteristics have been described that, although infrequent, can be very useful in its diagnosis

Urinotórax e insuficiencia renal crónica: una rara asociación / Urinothorax and Chronic Renal Failure: A Rare Combination

No disponible

Patrón micronodulillar pulmonar bilateral. ¿Variedad de posibilidades? / Pulmonary bilateral micronodulillar pattern. Differential diagnosis?

No disponible

Cambios en los parámetros bioquímicos del líquido pleural entre 2 toracocentesis consecutivas para diferenciar derrames malignos de benignos / Detection of Pleural Fluid Biochemistry Changes in Two Consecutive Thoracenteses for Differentiating Malignant from Benign Effusions

Objetivo: Evaluar si los cambios en los parámetros bioquímicos del líquido pleural (LP) entre 2 toracocentesis sucesivas permiten predecir derrames pleurales (DP) malignos o benignos. Métodos: Estudio retrospectivo de los pacientes con exudado linfocitario y citología negativa para malignidad que se sometieron a una segunda toracocentesis en nuestro centro durante los últimos 15 años (muestra de derivación), y en los que se alcanzó un diagnóstico final. Las diferencias absolutas (Δa) o porcentuales (Δp) de diferentes parámetros bioquímicos del LP capaces de predecir la naturaleza maligna o benigna del DP en la muestra de derivación se evaluaron en una población independiente. Resultados: Se incluyeron 214 pacientes con DP (70 malignos y 144 benignos) en la muestra de derivación. Las Δp LDH (lactato deshidrogenasa) > 0%, Δp neutrófilos > -10% (cualquier aumento o bien un descenso inferior al 10%), y Δa proteínas < 0,1 g/dL (cualquier descenso o bien un aumento inferior a 0,1 g/dL) entre la segunda y primera toracocentesis mostraron unas odds ratio de 6,4, 3,9 y 2,1 para discriminar DP maligno de benigno, respectivamente. La presencia de las 3 condiciones conjuntamente se asoció con una likelihood ratio positiva de 5,6, mientras que la ausencia de cualquiera ellas se asoció con una likelihood ratio negativa de 0,04 para predecir malignidad. Los resultados se reprodujeron en la población de validación. Conclusión: El aumento de LDH y neutrófilos, junto con el descenso de proteínas en una segunda toracocentesis, aumenta la probabilidad de que el origen del DP sea neoplásico, mientras que lo contrario la reduce significativamente

Objective: To assess whether changes in pleural fluid (PF) biochemistries between two consecutive thoracenteses enable clinicians to predict malignant or benign pleural effusions (PE). Methods: Retrospective study of patients with lymphocytic exudates and negative PF cytology, who underwent a second thoracentesis in our center in the last 15 years in whom a final diagnosis was reached (derivation sample). Absolute (Δa) and percentage differences (Δp) in PF biochemistries which predicted a malignant or benign PE in the derivation sample were evaluated in an independent population (validation sample). Results: The derivation sample included 214 PE patients (70 malignant and 144 benign PE). Δp lactate dehydrogenase (LDH) >0%, Δp neutrophils >-10% (any increase or less than 10% decrease) and Δa protein <0.1g/dL (any increase or less than 0.1g/dL decrease) between the second and the first thoracentesis had an odds ratio of 6.4, 3.9 and 2.1, respectively, to discriminate malignant from benign PE. The presence of the three conditions together had a positive likelihood ratio of 5.6, whereas the absence of any of the 3 parameters had a likelihood ratio of 0.04 for predicting malignancy. These results were reproduced in the validation sample. Conclusion: An increase in LDH and neutrophils along with a decrease in protein in a second thoracentesis increase the probability of malignant PE, while the opposite reduces it significantly

Análisis del líquido pleural: parámetros bioquímicos de uso infrecuente / Pleural fluid analysis: Biochemical parameters of infrequent use

El estudio bioquímico del líquido pleural es, con frecuencia, fundamental para el diagnóstico de la etiología del derrame. Existen parámetros básicos que aportan información relevante de forma inmediata (pH, glucosa, proteínas, lactato deshidrogenasa, adenosina desaminasa). Pero también existen otras magnitudes bioquímicas que pueden permitir el diagnóstico de determinadas causas de los derrames, como beta-2 transferrina, proteína-traza, creatinina, amilasa, bilirrubina, colesterol y triglicéridos o proteína C reactiva. Sin embargo, con frecuencia se solicitan al laboratorio numerosos parámetros de dudosa utilidad. La relación entre el médico asistencial y el laboratorio clínico es esencial para obtener la mayor rentabilidad diagnóstica del análisis bioquímico en líquido pleural. Una adecuada selección de los parámetros bioquímicos, a través del conocimiento y de la información compartida, conlleva una mejor aproximación diagnóstica en el estudio del derrame pleural

Biochemical studies of the pleural fluid are often a key step in the diagnostic workup. Several parameters (pH, glucose, protein, lactate dehydrogenase, adenosine deaminase) add immediate relevant information, or they can help in the diagnosis of specific causes of pleural effusion (beta-2 transferrin, beta-trace-protein, creatinine, amylase, bilirubin, cholesterol, triglycerides, and C-reactive protein). However, parameters of questionable value may also be requested. The relationship between the attending physician and the clinical laboratory is critical in order to obtain higher diagnostic efficiency. An accurate selection of the biochemical tests to perform achieves the best approach to the study of a pleural effusion

Análisis del líquido y elastancia pleurales como predictores de respuesta a la pleurodesis en los derrames pleurales malignos / Pleural Fluid Analysis and Pleural Elastance as Predictors of Response to Pleurodesis in Patients With Malignant Pleural Effusion

No disponible

Linfoma pleural primario asociado a piotórax / Pyothorax associated primary pleural lymphoma

RESUMEN: presentamos el caso de un paciente varón, exfumador, con antecedentes de empiema crónico de origen tuberculoso, que consultó por dolor torácico. Una tomografía computerizada (TC) demostró una pérdida de volumen en hemitórax derecho, con paquipleuritis calcificada asociada a colección hipodensa pleural, así como una lesión de partes blandas en contigüidad con la referida colección sugestiva de empiema necessitatis. En una tomografía por emisión de positrones (PET) se objetivó masa hipermetabólica de intensa captación en pared torácica derecha con afectación pleural. Se realizó biopsia guiada por TC con diagnóstico de linfoma no Hodgkin. El linfoma pleural primario representa el 7% de los casos de linfoma. Habitualmente afecta a pacientes con antecedentes de infección VIH o piotórax crónico. Los síntomas más frecuentes son disnea y dolor torácico. El diagnóstico se realiza mediante biopsia guiada o videotoracoscopia. El tipo histopatológico de linfoma pleural más descrito es el linfoma de células B grandes difuso

ABSTRACT: We present the case of a male patient, former smoker, with a history of chronic tuberculosis empyema, complaining of thoracic pain. A computerized tomography (CT) scan showed volume loss in the right hemithorax, with calcified pachypleuritis associated with hypodense pleural collection, as well as a soft tissue lesion contiguous with said collection, suggestive of empyema necessitans. A positron emission tomography (PET) scan showed a hypermetabolic mass with intense uptake on the right thoracic wall with pleural involvement. A CT-guided biopsy was done, obtaining a diagnosis of non-Hodgkin lymphoma. Primary pleural lymphoma accounts for 7% of all lymphoma cases. It normally affects patients with a history of HIV infection or chronic pyothorax. The most frequent symptoms are dyspnea and thoracic pain. Diagnosis is made using guided biopsy or videothoracoscopy. The most commonly described histopathological type of pleural lymphoma is diffuse large B-cell lymphoma

Manejo de la pancreatitis aguda grave en niños. Serie de 3 casos / Management of severe acute pancreatitis in children. A series of 3 cases

La pancreatitis aguda es una entidad poco frecuente en la población pediátrica, cuya incidencia ha aumentado en las últimas dos décadas. Sin embargo, existen pocos estudios sobre esta afección, por lo que su manejo terapéutico resulta muy variable, especialmente en los casos graves. En este trabajo describimos nuestra experiencia sobre el manejo en una unidad de cuidados intensivos pediátrica de 3 casos clínicos con esta afección en los últimos meses. En ellos se aplicaron las directrices extraídas de las guías clínicas sobre el manejo de la pancreatitis aguda en pacientes adultos basadas en la optimización de la analgesia, la administración de fluidoterapia i.v. agresiva y el reposo pancreático inicial con reintroducción precoz de la nutrición enteral, con lo que mostraron una buena evolución clínica posterior. Nuestro objetivo principal, dado el aumento en la incidencia de esta entidad, es destacar la importancia de un alto nivel de sospecha clínica ante un cuadro de dolor abdominal que permita un diagnóstico precoz y la rápida instauración de un tratamiento adecuado en estos casos, así como incidir en los puntos más importantes de su manejo

Acute pancreatitis is a rare entity among pediatric population, whose incidence has increased in the last two decades. However, there are few studies on this condition, so its therapeutic management is unsteady, especially in severe cases. In this article, we describe our experience in a pediatric intensive care unit in the management of 3 clinical cases with pancreatitis occured in the last months. We applied the guidelines extracted from the clinical guides about management of acute pancreatitis in adult patients, based on improving analgesia, administration of intensive fluid therapy and initial pancreatic rest with early reintroduction of enteral nutrition, which showed a good subsequent clinical evolution. Our main purpose, given the increase in the incidence of this entity, is to emphasize the importance of a high level of clinical suspicion when facing a case of abdominal pain that may allow an early diagnosis and a quick establishment of a proper treatment in these cases, as well as to highlight the most important facts of its management

Quilotórax secundario a linfoma no Hodgkin: una presentación poco habitual / Chylothorax secondary to non-Hodgkin Lymphoma: an unusual presentation

El quilotórax es una patología infrecuente que se produce por la efusión linfática de quilo al espacio pleural procedente del conducto torácico. Está causado por la obstrucción o perforación del mismo. Las causas del quilotórax son traumáticas, neoplasias, misceláneas e idiopáticas. Su diagnóstico debe sospecharse ante la apariencia lechosa y opalescente del líquido pleural, y se confirmará con la detección de triglicéridos o quilomicrones en el líquido. Clásicamente, su tratamiento se basa en medidas de soporte nutricional y drenaje del derrame. El pronóstico dependerá de la causa subyacente. Presentamos el caso de una paciente de 43 años estudiada por aumento de edemas en miembros inferiores y disnea de una semana de evolución, sin síndrome constitucional ni síntomas B asociados. En la exploración física se palpaban adenopatías a nivel de las regiones cervical, submandibular y supraclavicular izquierdas, junto con hipofonesis en base y campo medio izquierdos. La radiografía de tórax mostraba extenso derrame pleural izquierdo, realizándose toracocentesis diagnóstica, con líquido pleural de apariencia lechosa y opalescente e inmunofenotipo compatible con linfoma de célula grande. La tomografía computarizada y la biopsia quirúrgica de las adenopatías supraclaviculares, confirmaron el diagnóstico de linfoma no Hodgkin folicular

Chylothorax is an infrequent disease due to the lymphatic effusion of chyle into the pleural space from the thoracic duct. The causes of chylothorax are traumatic, tumors, miscellaneous and idiopathic. The diagnosis is suspected by the milky and opalescent appearance of the pleural fluid, and it will be confirmed by the detection of triglycerides or chylomicrons in the fluid. The treatment will be based on measures of nutritional support and drainage of the pleural effusion. The prognosis will depend on the underlying cause. We present a 43-years-old patient with 1-week history of increase edema of the lower limbs and dyspnea, without constitutional syndrome or B symptoms associated. On physical examination, adenopathies were palpable at left cervical, submandibular and supraclavicular regions. Chest radiography showed extensive left pleural effusion. We did a diagnostic thoracocentesis and we got a milky and opalescent pleural fluid. The immunophenotype was compatible with large cell lymphoma. Computed tomography and surgical biopsy of the adenopathies confirmed the diagnosis of follicular non-Hodgkin Lymphoma