# Chylothorax as a Rare Complication of Hepatic Cirrhosis in the Absence of Ascites

## TL;DR

This paper presents a rare case of chylothorax in a patient with liver cirrhosis, highlighting the challenges in diagnosing this condition without typical symptoms.

## Contribution

The paper contributes a rare clinical case emphasizing the under-recognized complication of chylothorax in hepatic cirrhosis without ascites.

## Key findings

- Chylothorax was diagnosed in a cirrhotic patient without ascites through pleural fluid analysis.
- The patient showed significant improvement after chest tube placement and dietary changes.
- The case underscores the importance of considering chylothorax in cirrhotic patients with unexplained pleural effusion.

## Abstract

Chylothorax, a rare complication of hepatic cirrhosis, is often under-recognized in the absence of ascites or other classical signs of portal hypertension. The diagnosis can be challenging due to its infrequent presentation, which highlights the clinical significance of this case. A 57-year-old male with a history of decompensated liver cirrhosis presented with progressive dyspnea. Imaging showed a right-sided pleural effusion. Pleural fluid analysis confirmed chylothorax, with elevated triglycerides and normal cholesterol levels. The patient underwent chest tube placement, which resulted in the drainage of 2 L of chylous fluid and marked symptomatic improvement. Further management included admission to the intensive care unit, initiation of total parenteral nutrition (TPN), and transition to a low-fat diet. The patient was transferred to an academic center as his clinical status failed to improve. This case portrays the diagnostic challenges of the etiology of chylothorax in patients with hepatic cirrhosis and emphasizes the role of portal hypertension in disrupting lymphatic drainage. Increased awareness of this rare complication is essential for timely recognition and appropriate management.