Lipid Pleural Effusions

Agrawal, Vishal; Sahn, Steven A.

doi:10.1097/maj.0b013e31815d2634

Cited by 55 publications

(62 citation statements)

References 22 publications

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“…It is believed that, as a result of the pleural thickening that blocks the drainage of fluids to the pleural wall lymphatic system, the cholesterol and lecithinglobulin complexes liberated after red cell and neutrophil lysis in the PF become trapped in the pleural cavity. In fact, some authors consider the PCT as a form of "lung entrapment" in the context of chronic inflammation (1). The diagnosis of PCT is established by the evaluation of the PF: milky PE, cholesterol level greater than 200 mg/dL, triglyceride level typically below 110 mg/dL [always with a cholesterol/triglycerides ratio (CHOL/TG ratio) >1], and often with cholesterol crystals seen on microscopy (1,4,5).…”

Section: Introductionmentioning

confidence: 99%

“…In fact, some authors consider the PCT as a form of "lung entrapment" in the context of chronic inflammation (1). The diagnosis of PCT is established by the evaluation of the PF: milky PE, cholesterol level greater than 200 mg/dL, triglyceride level typically below 110 mg/dL [always with a cholesterol/triglycerides ratio (CHOL/TG ratio) >1], and often with cholesterol crystals seen on microscopy (1,4,5). The initial step in the management of PCT is treatment of the underlying disease process, which is usually benign.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of patients with pseudochylothorax—a systematic review

Lama¹,

Ferreiro²,

Toubes³

et al. 2016

J. Thorac. Dis.

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Background: Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory disorders. Nevertheless, the characteristics of patients with PCT are poorly defined.Methods: A systematic review was performed across two electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of PCT. Case descriptions and retrospective studies were included.Results: The review consisted of 62 studies with a total of 104 patients. Median age was 58 years, the male/ female ratio was 2.6/1, and in the 88.5% of cases the etiology was tuberculosis (TB) or rheumatoid arthritis (RA). PE was usually unilateral (88%) and occupied greater than one-third of the hemithorax (96.3%). There was no evidence of pleural thickening in 20.6% of patients, and 14 patients had a previous PE. The pleural fluid (PF) was an exudate, usually milky (94%) and with a predominance of lymphocytes (61.1%). The most sensitive tests to establish the diagnosis were the cholesterol/triglycerides ratio (CHOL/TG ratio) >1, and the presence of cholesterol crystals (97.4% and 89.7%, respectively). PF culture for TB was positive in the 34.1% of patients. Favorable outcomes with medical treatment, therapeutic thoracentesis, decortication/ pleurectomy, pleurodesis, thoracic drainage and thoracoscopic drainage were achieved in 78.9%, 47.8%, 86.7%, 66.6%, 37.5% and 42.9%, respectively.Conclusions: PCT is usually tuberculous or rheumatoid, unilateral and the PF is a milky exudate. The presence of cholesterol crystals and a CHOL/TG ratio >1 are the most sensitive test for the diagnosis. The lack of pleural thickening does not rule out PCT. Treatment should be sequential, treating the underlying causes, and assessing the need for interventional techniques.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics of patients with pseudochylothorax—a systematic review

Lama¹,

Ferreiro²,

Toubes³

et al. 2016

J. Thorac. Dis.

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“…Usu ally uni la te ral ple u ral ef fu si on is se en, ho we ver ca ses with bi la te ral ef fu si on ha ve be en al so re por ted. 7 Tho rax CT of our ca se re ve a led bi la te ral ple u ral ef fu si ons. Fin dings in di ca ting a chro nic pro cess we re al so ob ser ved which inc lu ded vo lu met ric loss of the left lung, left ward shif ting of he art and me di as ti num, and ple u ral thic ke ning.…”

Section: Discussionmentioning

confidence: 82%

“…5 Pse u doch ylot ho rax is se en in chro nic ple u ral ef fu si ons with a me an la tent pe ri od of fi ve ye ars and a ti me in ter val of 11-15 ye ars. 7 In all di sor ders that le ad to ple u ral con so li da ti on and fib ro sis, pseu doch ylot ho rax can de ve lop, ho we ver the most fre qu ently en co un te red thre e eti o lo gi es are tu bercu lo sis, RA and the ra pe u tic pne u mot ho rax.…”

Section: Discussionmentioning

confidence: 99%

“…On mic ro bi o lo gi cal exa mi na ti on ne utrop hils are do mi nant cell types. 7 Sin ce ple u ral biopsy has a lo wer di ag nos tic va lu e in pre dic ting eti o logy, it sho uld not be con si de red in the first pla - ce. 8 Re sults of the bi oc he mi cal analy sis of the pleu ral flu id of our ca se we re comp le tely in ac cor dance with the di ag no sis of pse u doch ylot ho rax.…”

Section: Discussionmentioning

confidence: 99%

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Pseudochylothorax Secondary to Rheumatoid Arthritis: Case Report

Inonu¹,

Yeğinsu²,

Yücesoy³

et al. 2011

Turkiye Klinikleri J Med Sci

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1274 seudochylothorax, which is also termed as chyliform pleural effusion or cholesterol pleural effusion is an entity that develops as a result of increase in the amount of cholesterol in fluids with long-standing exudative characteristics and resembles to chylothorax.1 It is generally observed in pleural effusions lasting more than five years.2 Up to 1999, a total of 29 publications and 172 case reports regarding pseudochylothorax which is a rare form of pleural effusions have been cited in the literature. 3 The most common causes of pseudochylothorax are tuberculous pleurisy, chroPseudochylothorax Secondary to Rheumatoid Arthritis: Case Report A AB BS S T TR RA AC CT T A 61-year-old women was referred to our clinic because of bilateral pleural fluid in her chest X-ray. Her history revealed that swelling and stiffness in her joints was diagnosed as rheumatoid arthritis five years ago. On admission, the patient had no complaints, appeared well, and her vital signs were normal. Lung examination revealed that breath sounds were diminished in both lung bases. We did thoracentesis which yielded a milky-odorless fluid. Biochemical characteristics of the fluid was consistent with exuda; trigliseride: 20 mg/dl, cholesterol: 286 mg/dl. Direct smear and culture for acid fast bacilli were negative. Thoracic computerized tomography scans revealed bilateral pleural fluid, volume loss of the left lung with ipsilateral shifting of mediastinum. According to clinicoradiological and laboratory findings, we concluded that pseudochylothorax was the result of chronic rheumatoid pleurisy. Since pseudochylothorax is an uncommon entity detected during the analyses of pleural fluids, we intended to present our rarely seen case with pseudochylothorax.K Ke ey y W Wo or rd ds s: : Arthritis, rheumatoid; pleurisy; chylothorax; cholesterol; triglycerides Ö ÖZ ZE ET T Altmış bir yaşında bayan hasta, akciğer grafisinde bilateral plevral efüzyon nedeniyle kliniğimize yönlendirilmiş. Özgeçmişinde; beş yıl önce eklemlerinde şişlik-tutukluk şikayeti olmuş, romatoid artrit tanısı konulmuş. Kliniğimize başvurusunda yakınması yoktu, fizik muayenesinde genel durumu iyi, vital bulguları stabildi. Bilateral akciğer bazallerinde solunum sesleri hafif azalmıştı. Torasentezle alınan mayi sütsü görünümde, kokusuz, biyokimyasal incelemesi eksüda karakterinde, trigliserid: 20 mg/dl, kolesterol: 286 mg/dl idi. Sıvının asit rezistan bakteri teksif ve kültür incelemesi negatifti. Bilgisayarlı toraks tomografisinde bilateral plevral efüzyon, sol akciğerde volüm kaybı, kalp ve mediastende sola deviasyon tespit edildi. Mevcut klinik-laboratuvar ve radyolojik bulgularla kronik romatoid plöreziye bağlı psödoşilotoraks kabul edildi. Psödoşilotoraks plevra sıvıları içinde nadir görüldüğünden olgu sunulmuştur. Handan İNÖNÜ, MD,

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Diseases of the Pleura

Popper

2021

Pathology of Lung Disease

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Lipid Pleural Effusions

Cited by 55 publications

References 22 publications

Characteristics of patients with pseudochylothorax—a systematic review

Characteristics of patients with pseudochylothorax—a systematic review

Pseudochylothorax Secondary to Rheumatoid Arthritis: Case Report

Diseases of the Pleura

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