A pleuro-peritoneal communication through the diaphragm affected with lymphangioleiomyomatosis

Intern Med. 2010;49(5):439-45. doi: 10.2169/internalmedicine.49.2714. Epub 2010 Mar 1.

Abstract

A 30-year-old Japanese woman with lymphangioleiomyomatosis (LAM) developed a left chylothorax and chylous ascites. A pleuro-peritoneal communication was confirmed by a scintigram with (99)mTc-labeled macroaggregated-albumin injected into the peritoneal cavity. Video-assisted thoracic surgery revealed a protruding papillary lesion on the left diaphragm. Chyle was oozing into the pleural cavity through this lesion. Histopathological analyses demonstrated that the protrusion was a diaphragmatic LAM lesion and that LAM-associated lymphangiogenesis enabled communication between the pleural and peritoneal cavities through lymphatic vessels. This case demonstrated a new mechanism for chylous pleural effusion in LAM and illustrates the significance of LAM-associated lymphangiogenesis.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chylothorax / etiology
  • Chylous Ascites / etiology
  • Diaphragm*
  • Female
  • Humans
  • Lymphangioleiomyomatosis / complications*
  • Lymphangioleiomyomatosis / surgery
  • Lymphatic Vessels / diagnostic imaging
  • Lymphatic Vessels / physiopathology
  • Muscle Neoplasms / complications*
  • Muscle Neoplasms / surgery
  • Peritoneal Cavity / diagnostic imaging
  • Peritoneal Cavity / physiopathology*
  • Pleural Cavity / diagnostic imaging
  • Pleural Cavity / physiopathology*
  • Radionuclide Imaging