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CASE REPORT
Gastropleural fistula masquerading as chylothorax in a child with lymphoma
  1. Pharsai Prasertsan,
  2. Wanaporn Anuntaseree,
  3. Kanokpan Ruangnapa and
  4. Kantara Saelim
  1. Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
  1. Correspondence to Pharsai Prasertsan, pharsai_16{at}yahoo.com

Abstract

We report the case of an 8-year-old boy with diffuse large B cell lymphoma who developed a right-sided spontaneous pneumothorax with pleural effusion after recovery from septic shock. The pleural fluid was thought to be malignancy-associated chylothorax concomitant with complicated pleural effusion due to a milky-like appearance, a high level of triglycerides and Gram-negative bacteria staining in the fluid. He was put on total parental nutrition and octreotide for 2 weeks, but did not improve. The laboratory results also showed a persistent bacterial infection in the pleural fluid despite appropriate antibiotics. Eventually, a CT scan revealed a fistulous tract between the right pleural cavity and the stomach. Fistula repair was successful by right open thoracotomy with decortication. Even though the gastropleural fistula is a very rare condition in paediatric patients, the physician should consider this diagnosis in a patient who has an unusual presentation or refractory chylothorax-like pleural effusion.

  • paediatric oncology
  • pleural infection
  • pneumothorax
  • empyema
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Footnotes

  • Contributors PP wrote the first draft of the manuscript; KS provided figures and data; WA and KR performed the final approval of the version published. All authors reviewed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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