Complete Resolution of Chylopericardium after Chemotherapy for Chronic Lymphocytic Leukemia

Abstract

Nontraumatic chylous pleural effusions (chylothorax) and pericardial effusions (chylopericardium) are rare. They can, however, accompany intrathoracic malignancies and, most commonly, lymphomas. An association of chronic lymphocytic leukemia (cll) with chylopericardium has rarely been reported. A 68-year-old woman with cll, previously treated with single-agent fludarabine in the community, developed pleuritic chest pain and a new pericardial effusion. Computed tomography (ct) imaging of her chest revealed a large pericardial effusion with progressive lymphadenopathy. Pericardiocentesis identified a chylous effusion, and complete evacuation was achieved by catheter drainage. The cll was not treated. An asymptomatic pericardial effusion subsequently recurred. Pericardiocentesis was not repeated. Lymph node biopsy and flow cytometry revealed no evidence of large-cell lymphoma transformation. The patient was treated with 6 cycles of chlorambucil and obinutuzumab. Imaging of her chest by ct between cycles 2 and 3 revealed a marked resolution of the intrathoracic lymphadenopathy, with complete disappearance of the pericardial effusion. Repeat imaging at 5 months and again at 3 years after completion of chemotherapy demonstrated no recurrence of either the lymphadenopathy or the pericardial effusion. The mechanism of production and the treatment of chylous effusions are poorly defined. In this case, resolution of the pericardial effusion with effective chemotherapy is postulated to have alleviated obstruction of anterograde lymphatic flow facilitating drainage into the systemic venous system and allowing for spontaneous complete resolution of the pericardial effusion without surgical intervention.

Complete resolution of chylothorax with ibrutinib in chronic lymphocytic leukemia: a case report

“…In general, the initiation of treatment depends on the Rai and Binet staging system and the presence of disease-related symptoms or not (10). Chylothorax, as a result of CLL, has only been reported in dozens of cases and rarely occurs during the late stage of the disease (12,13). Four months before the visiting to us, our patient was found to have multiple lymphadenopathies in the whole body during a routine physical examination and diagnosed with CLL/SLL in other hospital.…”

Cardiac Involvement in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

“…Pericardiocentesis was performed, and 1150 mL of serosanguineous pericardial fluid was removed with immediate improvement and resolution of tachypnea. Morris et al observed a case of a 68-year-old woman who developed pleuritic chest pain and pericardial effusion three years after CLL diagnosis [ 24 ]. Computed tomography (CT) imaging identified a large pericardial effusion with lymphadenopathy.…”

“…In the pericardial fluid, the cell count was 18.4 × 109/L with 98% lymphocytes and CLL cell immunophenotype CD19+, CD20+, CD5+, CD10−, CD38+, CD43+, CD71−, CD23+ in 32% of the cells. However, an asymptomatic pericardial effusion subsequently recurred, and the patient received six cycles of chlorambucil and obinutuzumab, resulting in complete disappearance of the pericardial effusion without second pericardiocentesis [ 24 ]. Finally, Almeda et al discuss the case of a 64-year-old man diagnosed with a tumor infiltrating the myocardium and pericardium, which produced necrotic tissue that masqueraded as pericardial tamponade [ 25 ].…”

Delayed chylopericardium after radical surgery for esophageal cancer: a case report

“…Occasionally, chylopericardium can occur after cardiac surgery. Other rare causes of chylopericardium include venous thrombosis of the upper extremity and tumors ( 1 – 3 ). However, chylopericardium is rare.…”