Chylothorax as the initial manifestation of malignant Hodgkin lymphoma

A 22 year-old man complaining of slight thoracic pain, was found to have a right pleural effusion in his chest X-ray. The pleural aspiration yielded chylous fluid and radiological examination and biopsy of a mediastinal mass led to the diagnosis of Hodgkin's disease of the nodular sclerosis type with supra- and radiologically infradiaphragmatic disease and a pathological fracture of the sternum. After complete initial aspiration of the pleural effusion the chylothorax did not recur following initiation of a combination chemotherapy, and a clear regression of the lymphoma was found after the first 3 cycles. This case provides an example of an oligosymptomatic, right sided chylothorax as the first manifestation of Hodgkin's disease in a young immuno-competent patient.