She has multinodular goiter diagnosed also about a year ago, actually had a biopsy on the left neck for this that she states was benign. Her meds include Quinapril,
Chlorthalidone, Metformin, Tamoxifen (don't know why) and prednisone 5 mg QD.
She is a lifelong nonsmoker.
On exam, she has a very large goiter, and dullness to percussion over the left chest.
Her pleural fluid is shown here:
Thoughts?
The fluid looks chylous. Maybe the tamoxifen was for a breast Ca and all that soft-tissue density in the CT are mets to nodes with lymphatic compression and a chylothorax.
ReplyDeleteSarcoidosis and even the goiter itself can also cause chylothoraces.
ReplyDeleteI guess the first step of course is to get the chemical studies and cell analysis on the fluid.
The WBC's in the fluid were 2800 with 95% lymphocytes.
ReplyDeletepH 7.79, LDH 126 (serum 155), protein 5.5 (serum 8.6), glucose 148.
Trigylycerides pending.
The pic of the fluid is pretty cool. I guess an empyema could look like that on a posted pic but the numbers don't support that. I will take my chances with a chylothorax for now.
ReplyDeleteI agree-it looks chylous. The CT shows enlargement of some pre-vascular/peri-aortic nodes, and there's increased soft tissue in the superior mediastinum. Sarcoid is possible, but I'd be more concerned about a malignancy. I think a mediastinoscopy or even a Chamberland procedure is necessary to get tissue.
ReplyDelete