Chylothorax and Superior Vena Cava Syndrome Case Study

Chylothorax and Superior Vena Cava Syndrome Case turn overTitle Chylothorax and Superior Vena Cava Syndrome as the Initial Presentation of Non keen Cell Lung Cancer, which was Successfully Resolved by Systemic ChemotherapyWe define a crusade makeup of 35 year old male endueed with curtness of breath, dyspnea, heaviness of left(a) government agency w exclusively, engorgement of vein in left gradient chest hem in and upper left deal, swelling in left align of the neck, chest pain and cough. At the clock of admission, an abnormal sharpshoot opacity presented in left upper lung lobe and histology shows non- ex boothent cell carcinoma with superior venous blood watercraft cava syndrome was diagnosed. MSCT scan report heterogeneous enhancing large soft tissue parsimony mass lesion of size approximately 96 100 mm seen in left upper lobe extending in to whole mediastinum encasing all major watercraft including arch of aorta, descending aorta, trachea, esophagus, pulmonary t runk,M PA and all major neck vessels origin. Lesion create significant luminal narrowing of left main bronchus. Lesion make obliteration of left brachio-cephalic.Left moderate pleural effusion seen. Heterogeneous cut adjust lung field is seen due to mosaic perfusion. Left sided thoracocentesis through milky discolor swimming drained from pleural pit. Ultrasonography channelize FNAC left lung do is suggestive of non-small cell carcinoma. Superior vein cava syndrome associated with lung carcinoma with monolithic chylothorax. Patient have cisplatin and gemcitabine chemotherapy. After chemotherapy interpreted chylothorax resolution well-nigh completely. observe words Lung genus Cancer squamous cell carcinoma chylothorax superior vena cava syndromeINTRODUCTIONLung cancer in India commonly accounts 80-85% of non-small cell carcinoma. In Acharya tulsi regional cancer handling and research institute Bikaner hospital squamous cell carcinoma interpretation for 15% of all ends o f NSCLC according to registry. In advanced lung cancer chemotherapy play main subprogram in quality of life and survival. Chylothorax initial symptom of NSCLC is rargon only when pleural effusion is commonly seen. Chylothorax is mostly seen after complication of lung surgery. just now in this causa chylothorax is initial presentation with NSCLC with SVC. Incidence of chylothorax is .3-2.4%.3-5. Few report of this disorder in current year2. We report this case of NSCLC with initial coming into court with SVC and chylothorax which resolvingd well-nigh entirely with chemotherapyCASE REPORTA case report of 35 year old male presented with shortness of breath, dyspnea, heaviness of left chest wall, engorgement of vein in left side chest wall and upper left neck, swelling in left side of the neck, chest pain and cough. He is heavy smoker for 13 year and also chronic alcohol drinker. Patient vital signs at the time of admission pulse rate is 88 per minute, respiratory rate is 26 per mi nute, BP is 128/84 and temperature in normal limit. On auscultation breathe sound lessen in left side of chest. At the time of admission, an abnormal expound opacity presented in left upper lung lobe and histology shows non-small cell carcinoma with superior vena cava syndrome was diagnosed. MSCT scan report heterogeneous enhancing large soft tissue tightness mass lesion of size approximately 96 100 mm seen in left upper lobe extending in to whole mediastinum encasing all major vessel including arch of aorta,descending aorta, trachea, esophagus, pulmonary trunk,M PA and all major neck vessels origin. Lesion causing significant luminal narrowing of left main bronchus. Lesion causing obliteration of left brachio-cephalic.Left moderate pleural effusion seen.Heterogeneous attenuated right lung field is seen due to mosaic perfusion. Multiple para-esophageal,perigastric, supra-clavicular,superior mediastinum, pre, paratracheal, subcarinal AP window lymphadenopathy argon seen,larger qua ntity approx. 18 mm size. Left sided thoracocentesis through milky white eloquent drained from pleural perdition. Ultrasonography guided FNAC left lung done is suggestive of non-small cell carcinoma. Superior vena cava syndrome associated with lung carcinoma with massive chylothorax. Patient received cisplatin and paclitaxil chemotherapy. cisplatin given D1 and D2 schedule. After deuce circle chemotherapy taken chylothorax resolve almost completely.Laboratory investigation shows serum creatinine e 1.1 mg /dl, albumin 3.2 mg/dl, append cholesterol 193 mg/dl, serum triglyceride, 93 mg/dl, LDH is 425 IU/l. thoracocentesis done and 2000 ml milky white coloured swimming drained. Milky fluid biochemistry done and shows triglyceride, 867 mg/dl lactate dehydrogenase, 332 IU/l and carcinoembryonic antigen, 6.16 ng/ml.The cytological analysis of fluid revealed no malignant cells. Intercostal tube inserted and fluid is drained and symptom is improved. The clinical stage was T3N2aM0 stage IIIb. Therefore, SCC of the lung complicated by chylothorax and SVCS was diagnosed. . Chemotherapy with paclitaxel (175 mg/m2) and cisplatin (75 mg/m2) was administered on days 1, and cisplatin give in ii days in divided dose respectively of six cycle repeat 21-day. The dyspnea and shortness of breath improved after twain cycle of chemotherapy and amount of milky fluid drained is gradually tapered in intercostal tube after chemotherapy given. After five cycles chemotherapy unhurried symptoms improved and neck swelling is disappear and intercostal drained is 230 ml/day so intercostal tube come out and stay one cycles is given. After 6 cycle complete again CECT chest revealed tumor size significantly decreases and also pleural fluid almost disappear but superior vena cava symptoms is minimally improved . accordingly subsequently, the patient put another chemotherapy with gemcitabine and carboplatin, and light beam is given to chest wall 30 gy 300cGy per fraction total 10 fracti on in 2 weeks, but the tumor eventually progressed.DiscussionThe relationship between lung cancer and chylothorax may occur after compression of tumor to thoracic channel so increase pressure to duct and ruptured 6. Secondly in obstructor in superior vena cava so venous pressure is change magnitude significantly so leakage of chyle from thoracic duct to pleural cavity 7-9. Another Couse of chylothorax is side effect of radiotherapy because after radiotherapy fibrosis is on that point and diminishing of lymph circulation 10-13. This complication of radiation treatment is also observed in many disease like Hodgkin lymphoma (mantle field technique), squamous cell carcinoma in esophagus, teat carcinoma and also lung carcinoma 10,11, 12, 13, . With out lung surgery chylothorax is rare but this case present chylothorax without surgery. In current year 3 case reported with non small cell carcinoma2,10,14-16.table 1 shows patient have chylothorax with clinical manifestation and resolve after management. In this table include our case report.The three case report series have 2 male and one female and median age af all three case was 47 yrs. entirely case non small cell carcinoma sub group is squamous cell carcinoma. Dahlbalk et al.17 shows squamous cell carcinoma of lung cancer present with thorasic duct fluid in pleural cavity and nodular depositation. All case presented with right side lung carcinoma. Pleural fluid cytology present wih malignant cell. Main dominant feature in case is chylothorax and its present in chiefly right pleural space.Treatment of chylothorax is mainly frequently repeated aspiration of pleural fluid, low fatty diet, intercostal tube drainage, and pleurodesis with chemical substance. 6,18 surgical management of chylothorax is thorasic duct ligation and pieuroperitonial shunt are mainly used in when milky coulred fluid is more than 550 ml or more then continues 14 days. In Dahlbalk et al contain mainly two case successfully treated wi th chemical pleurodesis. hotshot patient any intervention not done because general ensure is very poor give only paliiative treatment. If chylothorax associated with cloot in brachiocephalic vein or subclavian and jugular vein is treated with anticoagulant therapy. Beghetti et al8. studied resistive case of chylothorax associated with superior vena cava syndrome manage with chemotherapy. Our case usual taken four cycle chemotherapy and mostly resoved chylothorax . Thrombus in superior vena cava are correct with treatment of underlying couse. Symptoms of superior vena cava syndrome is extremlly improved with two cycle chemotherapy. It is revealing of a promising response to chemotherapyTable 1 three patients of non-small cell lung cancer presented with ChylothoraxAbbreviationsSCC=squamous cell carcinoma RML=right middle lung RT= radiotherapy C/T=chemotherapy NA=not available