Chylothorax or leakage of total parenteral nutrition?

Abstract

The diagnosis chylothorax is based on a chemical analysis of the pleural effusion. According to the literature, this analysis can be rather straightforward, comprising measurements of triglycerides, chylomicrons, and cholesterol. In this report we present an autopsy case that alerted us to interpret these results critically. Although the laboratory tests of the pleural effusion in this patient with parenteral nutrition suggested chylothorax, additional tests (potassium (11.3 mmol.L(-1)) and glucose (128 mmol.L(-1)) proved otherwise. Comparison of the pleural effusion analysis and the content of the parenteral nutrition led to the final conclusion that the effusion was due to a leakage of parenteral nutrition instead of chylothorax. We therefore suggest adding glucose and potassium measurements to the biochemical work-up of a patient under suspicion of chylothorax.

Pleural effusions in the neonate

“…A high concentration of glucose and potassium usually helps to the diagnosis of total parenteral nutrition leakage [9].…”

Chyle Leakage and Early Enteral Feeding following Pancreatico-Duodenectomy: Management Options

“…In the published literature there have been numerous case reports as well as collective reviews of chylothorax [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. However, there are relatively little data on chylous ascites.…”

“…Disruption of these lymphatic pathways can result in both chylothorax as well as chylous ascites. A variety of mechanisms can result in a chyle leak ranging from congenital defects of the lymphatic system to malignancy or trauma [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. However, chyle leaks are also a recognised complication of abdominal, thoracic and head and neck surgery [1,2,4,5,6,7,8,9,12,13, 15, 18].…”

Differential diagnosis of chylothorax in a patient on parenteral nutrition: a case report

“…5 On the other hand, a high pleural glucose concentration is a rare biochemical finding. There have been case reports on PN leak, 9 oesophageal perforation 10 and peritoneal dialysis, 11 which have contributed to elevated glucose in pleural fluid. However, a suspected chylous fluid should have triglycerides and cholesterol measured, as well as glucose and osmolality in those receiving PN in order to prevent misdiagnosis and further unnecessary investigations.…”