Chylothorax diagnosis: can the clinical chemistry laboratory do more?

Gibbons, Stephen; Ahmed, Farhan

doi:10.1177/0004563214530677

Cited by 12 publications

(6 citation statements)

References 7 publications

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“…Additionally, the thoracic fluid collected in each cat at each time point had a fluid cholesterol to triglyceride ratio of less than 1, further supporting the classification of the fluid collected as normal lymphatic fluid. 25,26 There was little deviation outside the normal reference range for the systemic values evaluated in this study (cholesterol, triglycerides, PCV, total protein and lymphocyte count) with the exception of relatively mild changes in PCV, triglycerides, and lymphocyte count. It is likely that the mild elevation in PCV seen in two cats on day 3 and one cat on day 9 (50%, 51% and 53%) was due to mild dehydration as those cats also had total protein values in the high end of the normal range.…”

Section: Discussionmentioning

confidence: 61%

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A lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model

Hardie

Sheehan

2016

Lab Anim

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This study describes a lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model. The thoracic duct was cannulated via a left lateral intercostal thoracotomy in 12 cats. Lymphatic fluid was collected for up to 16 days and analyzed on days 3, 9 and 16. The volume collected and duration of cannula patency were recorded. Contrast imaging of the thoracic duct was performed if fluid ceased to flow or at the end of the 16-day study period. In two cats, the cannula became dislodged within 24 h. For the remaining 10 cats, mean daily volume collected was 43.7 mL (median 41.0, range 2.3 to 152.4 mL), and mean duration of cannula patency was 8.2 days (median 6.5, range 3 to 16 days). Contrast imaging revealed that the cannula was patent in three cats, obstructed in two cats, and the thoracic duct had ruptured or had extravasation of contrast outside the duct in five cats. Cytological examination of lymphatic fluid from the three time points revealed normal appearing small lymphocytes (97%) and few (3%) non-degenerate neutrophils, macrophages, eosinophils, and plasma cells. Based on the results of this study, lateral thoracotomy approach for thoracic duct cannulation is a feasible technique for collecting lymphatic fluid in cats. This technique may have application as a model for short-term evaluation of thoracic fluid in cats; however, cannula patency was unpredictable and should be considered when utilizing this technique.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

A lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model

Hardie

Sheehan

2016

Lab Anim

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“…Other studies noted that the appearance of fluid and volume of chest-drain output alone lack sensitivity and specificity for detection of chylous leakage, and they occasionally integrated physical and biochemical analysis of chyle into their management of diagnosis. 2,36 Until the findings of this study, we used 200 mL of chesttube output as the cutoff to remove the chest tube, and we did not take body weight into account. When we retrospectively evaluated our data, we found that patients' chest-tube output per kg body weight correlated well with clinical outcome and necessary treatment.…”

Section: Discussionmentioning

confidence: 99%

Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus

Brinkmann

Schröeder

Junggeburth

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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“…Lipoprotein electrophoresis, which identifies chylomicrons, remains the gold standard to confirm the diagnosis of chylothorax in pleural fluid. However, lipoprotein electrophoresis is no longer performed in most laboratories, but could provide important information for the diagnosis in difficult cases (9 ). In our case, the appearance of a white ring at the top of the pleural fluid sample after 12 h at 4°C confirmed the presence of chylomicrons.…”

Section: Discussionmentioning

confidence: 50%

Milky Pleural Fluid

et al. 2016

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A 90-year-old man was admitted for progressive dyspnea. His medical history included hypertension and chronic myeloid leukemia diagnosed 10 years before and treated with dasatinib. Physical examination revealed pitting edema of the legs and dullness to percussion in the right chest. Laboratory test results were clinically relevant for white blood cells 7.7 ϫ 10 9 /L (reference interval 4 -10 ϫ 10 9 /L), platelets 162 ϫ 10 9 /L (150 -400 ϫ 10 9 /L), hemoglobin 10.5 g/dL (13-18 g/dL), total protein 7.1 g/dL After 12 h at 4°C, the pleural fluid had a white ring at the top of the sample (Fig. 1). DiscussionThe first step in evaluation of a pleural effusion is to differentiate exudative and transudative effusions; this plays a key role in determining the etiology of the effusion. Both exudative and transudative fluids are characterized by translocation of excess fluid in the pleural cavity. The main difference is the functional integrity of the pleural membranes. Transudative effusions are defined by unaltered pleural membranes and characterized by increased hydrostatic pressure or decreased oncotic pressure. Exudative effusions are characterized by altered pleural membranes associated with increased permeability.The main etiologic factors leading to a transudative pleural effusion are heart disease such as heart failure or pericarditis, cirrhosis, nephrotic syndrome, peritoneal dialysis, hypoalbuminemia, general disease such as sarcoidosis or hypothyroidism, and pulmonary embolism. Exudative pleural effusions are mainly caused by malignancy (e.g., mesothelioma, lung metastasis, lymphoma), infectious disease (e.g., tuberculosis, pyogenic infection, empyema), general disease (e.g., systemic lupus erythematous, sarcoidosis), pulmonary embolism, abdominal disease (e.g., hepatitis, pancreatitis, abdominal surgery), hemothorax, and chylothorax.Several biochemical assessments (total protein, LDH, glucose, albumin, and pH) have been proposed to discriminate between transudative and exudative pleural effusions. However, criteria defined by Light et al. in 1972 remain the gold standard (1 ). According to those criteria, a ratio of pleural fluid to plasma total protein of Ͼ0.5 is commonly found in exudative pleural effusions. Likewise, pleural fluid LDH activity Ͼ200 U/L and a ratio of pleural fluid to plasma LDH of Ͼ0.6 are consistent with an exudate. In our case, the ratio of pleural fluid to serum protein was 0.6 and LDH activity was 291 U/L, both suggesting an exudative effusion, whereas the ratio of pleural fluid to serum LDH was 0.57, close to the cutoff threshold.The diagnostic sensitivity of Light's criteria (1 ) for the diagnosis of exudative pleural effusion is close to 100%, but the specificity is lower, at 80% (2 ). Some transudative pleural effusions could be classified as exudative pleural effusions according to these criteria. The gradient between albumin concentration in pleural fluid and in the blood is commonly Ͻ1.2 g/dL in exudative pleural effusions (3 ).In our case, visual inspection of the pleural fluid o...

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Chylothorax diagnosis: can the clinical chemistry laboratory do more?

Cited by 12 publications

References 7 publications

A lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model

A lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model

Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus

Milky Pleural Fluid

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