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A-42-Year-Old-Woman-With-Abnormal-Chest-CT-Scan-an
A-42-Year-Old-Woman-With-Abnormal-Chest-CT-Scan-an
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Pdf Summary
The case study discusses a 42-year-old woman with an abnormal chest CT scan and chylous ascites. Twenty years earlier, during a routine evaluation, an abnormal chest radiograph was noted, but follow-ups showed minimal disease progression and she remained symptom-free. A year prior to her current clinic visit, she developed abdominal discomfort identified as ascites, with fluid analysis revealing chylous ascites. Physical examination showed decreased air entry at lung bases and ascites without major distress signs.<br /><br />Diagnostic studies included normal laboratory tests and chest CT scans revealing extensive septal and peribronchovascular thickening alongside ground-glass opacities, cystic changes, and effusions. Subsequent echocardiogram and right-sided heart catheterization ruled out cardiac issues. Spirometry suggested a restrictive pattern, and a bronchoscopy with a BAL cell differential was performed without diagnostic results. Ultimately, a surgical lung biopsy was conducted revealing dilated lymphatic channels, leading to a diagnosis of pulmonary lymphangiectasia.<br /><br />Pulmonary lymphangiectasia is characterized by dilated lung lymphatics and is typically a developmental abnormality (primary) or from lymphatic/venous obstruction (secondary). Typically, it presents in children and is associated with high neonatal mortality, yet this case represents a rare adult presentation usually having localized rather than diffuse pulmonary involvement, posing a differential diagnostic challenge, including conditions like lymphangitic carcinomatosis and pulmonary veno-occlusive disorders. A CT scan typically shows interstitial opacities and other features, with lung biopsy confirming diagnosis.<br /><br />Treatment is mainly supportive, with dietary modifications such as low-fat or medium-chain triglyceride diets helping manage chylous effusions. In this case, after dietary adjustments, the patient did not show further chylous ascites accumulation and remained asymptomatic.<br /><br />Clinical insights highlight the unusual adult presentation of pulmonary lymphangiectasia, the benefit of dietary management, and the importance of recognizing imaging indicators for early diagnosis and management strategies.
Keywords
pulmonary lymphangiectasia
chylous ascites
abnormal chest CT
lung biopsy
dilated lymphatic channels
dietary management
ground-glass opacities
restrictive pattern
interstitial opacities
adult presentation
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