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Middle Aged Female with Shortness of Breath, Congestive Heart Failure and Left Pleural Effusion-What is the Diagnosis?

Andrey Manov, Smita Subramaniam, David Yi and Andrew Vories

A chylothorax is formed when the thoracic duct is disrupted and the chyle enters the thoracic space. The causes are traumatic-surgery or trauma to the chest and non-traumatic with malignancy and specifically lymphoma playing major role, idiopathic and miscellaneous-sarcoidosis, cirrhosis of the liver, heart disease, childbirth, Castleman's disease. Retrosternal goiter is an extremely rare cause of chylothorax and the first case described was in 1996. We are describing a 44 year old African-American female with left pleural effusion and multiple admissions due to it to the hospital. The left pleural effusion was attributed to be a result of heart failure with preserved ejection fraction which the patient had. Despite aggressive dieresis the patients left pleural effusion and shortness of breath persisted which let to 3 admissions to the hospital. After investigating further the effusion turned out to be chylothorax due to compression and disruption of the thoracic duct by enlarged retrosternaly located multinodular goiter. After left lobectomy and removal of the isthmus of the thyroid the left chylothorax resolved and never recurred in the following 4-years.