Case Report
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World J Gastroenterol. Feb 21, 2013; 19(7): 1140-1142
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1140
Transjugular intrahepatic portosystemic shunt in refractory chylothorax due to liver cirrhosis
Philipp Lutz, Holger Strunk, Hans Heinz Schild, Tilman Sauerbruch
Philipp Lutz, Tilman Sauerbruch, Department of Internal Medicine I, University of Bonn, 53129 Bonn, Germany
Holger Strunk, Hans Heinz Schild, Department of Radiology, University of Bonn, 53129 Bonn, Germany
Author contributions: All authors were involved in the clinical care of this patient and collaborated in writing this paper.
Correspondence to: Philipp Lutz, MD, Department of Internal Medicine I, University of Bonn, Sigmund-Freud-Str. 25, 53129 Bonn, Germany. philipp.lutz@ukb.uni-bonn.de
Telephone: +49-228-28719169 Fax: +49-228-28714322
Received: October 20, 2012
Revised: November 26, 2012
Accepted: December 15, 2012
Published online: February 21, 2013
Processing time: 124 Days and 22.4 Hours
Abstract

A pleural effusion containing chylomicrons is termed chylothorax and results from leakage of lymph fluid into the pleural cavity. We report on the case of a 59-year-old woman with severe dyspnea due to a large chylothorax. She was known to have liver cirrhosis but no ascites. There was no history of trauma, cardiac function was normal and thorough diagnostic work-up did not reveal any signs of malignancy. In summary, no other etiology of the chylothorax than portal hypertension could be found. Therapy with diuretics as well as parenteral feeding failed to relieve symptoms. After a transjugular intrahepatic portosystemic shunt (TIPS) had successfully been placed, pleural effusion decreased considerably. Eight months later, TIPS revision had to be performed because of stenosis, resulting in remission from chylothorax. This case shows that even in the absence of ascites, chylothorax might be caused by portal hypertension and that TIPS can be an effective treatment option.

Keywords: Chylothorax; Cirrhosis; Liver; Portal hypertension; Transjugular intrahepatic portosystemic shunt