PMC10338652_01
Upper Panel: Posteroanterior (A) and lateral (B) views of a chest X-ray taken upon hospital admission, revealing a radiolucent image in the right hemithorax indicative of a massive pleural effusion. The X-ray displayed a complete "white-out pattern," indicating a substantial accumulation of fluid in the pleural space. Lower Panel: High-resolution chest computed tomography, (C) coronal view, and (D) axial view. The images exhibit chylothorax as a septated pleural effusion, with the fluid not following gravity due to the presence of fibrotic tissue. Additionally, reactive paratracheal nodules are observed.
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The chest X-ray (CXR) showed a massive right pleural effusion (Figure 1, Panel A). Follow-up chest CT scan were obtained through this period revealing a persistent septated pleural effusion and enlarged reactive paratracheal nodules (Figure 1, Panel B).The pleural effusion was managed with open thoracostomy, but multiple subsequent thoracenteses were required to control the effusion, and none of them were initially successful.
Evolution of hematological parameters during hospitalization, depicting hemoglobin levels in red, white blood cell count (WBC) and absolute neutrophil count (ANC) in purple, and platelet count in yellow. A decline in all 3 parameters is observed until day 10 of hospitalization, followed by improvement after the administration of immunomodulatory management. The association with fever is displayed in the lower section, with the green bar representing no fever, the red bar indicating constant and high-grade fever, and the yellow bar representing intermittent low-grade fever. The green dotted lines denote the administration of different treatments: MTP (methyl prednisolone), IVIG (intravenous immunoglobulin), CYC (cyclophosphamide).
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The evolution of hematological parameters through admission is better shown in Figure 2.
Case report timeline of the hospitalization happenings. The colored squares show medical interventions perform in each timeframe.
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The case timeline is better shown in Figure 3.