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UKK: Respiratory
Category: ePoster Presentation
Code: P - RES - 030

Bilateral massive pleural effusion in malignancy

Dimas Dwi Saputro(1) , Rifan Fauzie (1) , Retno Widyaningsih(1)

Harapan Kita Women and Children Hospital(1)

Background: Lymphoma is the third most common malignancy of childhood. The incidence is still rare of
11% of childhood cancer. Pleural e usions frequently are symptomatic in children with and are almost
exclusively associated with non-Hodgkin’s lymphoma maligna (NHLM).

Objective: To present bilateral massive pleural effusion as one of complications of NHLM in children.

Case: We report an eight year old male child presented with fever since 2 months and acute onset of
dyspnea. He had history of weight loss. On examination, the child was malnourished and tachypnoeic. He
had palpable lymph nodes in cervical, axilla, and right inguinal region with size diameter of 1.5 cm. There
was marked dullness on percussion, decreased vocal resonance and breath sound over the both chest.
Thoracic X-ray investigations showed bilateral pleural e usion. Erythrocyte sedimentation rate and lactate
dehydrogenase (LDH) were high. Pleural fluid analysis revealed haemorrhagic fluid with low sugar, normal
protein, high total count and LDH. Ratio serum to pleural fluid LDH was 0.46, ratio serum to pleural fluid
protein was 0.6. Adenosine deaminase was high but negative for acid fast bacilli and malignant cells.
During the hospital stay, therapeutic pleural tapping was done which provided symptomatic relief to the
child. Contrast enhanced CT scan of abdoment revealed borderless mass with irregular edges on right
abdominal region, which appeared to come from the gut (size 13 cm x 9.6 cm x 18.4 cm). The metastatic
spread of tumor was absent. Open abdominal biopsy found small round cell tumour appearance suggestive
for NHLM. The child was then given chemotherapy according to NHLM protocol.

Conclusion: A high degree of suspicion is required to di erentiate bilateral pleural e usion for other
common causes in childhood. Since early diagnosis and prompt treatment are important to prevent further
complications of the disease.

Keyword : pleural, effusion, Non-Hodgkin, lymphoma, malignancy