title: Chylothorax in gastric adenocarcinoma: A case report and systematic review of the English literature.
abstract: BACKGROUND
  Chylothorax is a rare complication of gastric adenocarcinoma and data on its identification, prevalence and outcomes are scant.
  
  
  OBJECTIVE
  To enable identification of gastric carcinoma as a cause of chylothorax.
  
  
  METHODS
  A case report and a systematic review were conducted of all reported cases of gastric adenocarcinoma with chylothorax as the presenting complaint in the English literature.
  
  
  RESULTS
  Chylothorax is a rare presenting complaint of gastric adenocarcinoma. There are only 18 case reports in the world literature, of which six are in English. Chylothorax occurred variably in gastric adenocarcinoma, either as a presenting feature or as a complication of therapy. Here, we analyze the index case and six patients in whom gastric carcinoma presented with chylothorax as the initial symptom. Respiratory features of cough and dyspnea preempted any abdominal complaint. Bilateral chylothorax (66%) with associated chylous ascites (50%) was common. Four of the six patients had skin lymphedema also as a prominent feature. The chylothoraces have been treated by therapeutic pleurocentesis, intercoastal tube drainage and restriction of oral intake. Gastric adenocarcinoma was associated with high mortality (50%) and morbidity.
  
  
  CONCLUSIONS
  Chylothorax can be the presenting feature of gastric adenocarcinoma. A thorough search for this life-threatening disease should be done before labeling the chylothorax as idiopathic.
authors.affiliation: Department of Chest Medicine, St. John's Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Uma
authors.initials: U
authors.lastname: Devaraj
authors.affiliation: Department of Chest Medicine, St. John's Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Ramachandran
authors.affiliation: Department of Pathology, St. John's Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Correa
authors.affiliation: Department of Chest Medicine, St. John's Medical College and Hospital, Bangalore, Karnataka, India.
authors.forename: George A
authors.initials: GA
authors.lastname: D'souza
keywords: Chylothorax; gastric adenocarcinoma; lymphedema