Pleural Fluid Characteristics of Chylothorax

Abstract

OBJECTIVE:To determine the biochemical parameters of chylous pleural fluids and better inform current clinical practice in the diagnosis of chylothorax. PATIENTS AND METHODS:We retrospectively reviewed 74 patients with chylothorax (defined by the presence of chylomicrons) who underwent evaluation during a 10-year period from January 1, 1997, through December 31, 2006. The biochemical parameters and appearance of the fluid assessed during diagnostic evaluation were analyzed. RESULTS:The study consisted of 37 men (50%) and 37 women (50%), with a median age of 61.5 years (range, 20-93 years). Chylothorax was caused by surgical procedures in 51%. The chylous pleural fluid appeared milky in only 44%. Pleural effusion was exudative in 64 patients (86%) and transudative in 10 patients (14%). However, pleural fluid protein and lactate dehydrogenase levels varied widely. Transudative chylothorax was present in all 4 patients with cirrhosis but was also seen with other causes. The mean ± SD triglyceride level was 728±797 mg/dL, and the mean ± SD cholesterol value was 66±30 mg/dL. The pleural fluid triglyceride value was less than 110 mg/dL in 10 patients (14%) with chylothorax, 2 of whom had a triglyceride value lower than 50 mg/dL.

INTERACTIVE CASE REPORT: A Case of Idiopathic-Bilateral Chylothorax

“…The biochemical criterion for chylothorax is when the pleural fluid triglyceride level is greater than 110 mg/dL. Pleural fluid with a triglyceride level greater than 110mg/dL has less than a 1% chance of not being chylous (8). Conversely, a pleural fluid triglyceride level less than 50 mg/dL indicates no more than a 5% chance of being chylous.…”

A chylothorax modern kezelésének bizonyítékalapú áttekintése

“…Típusosan thoracocentesissel opálos, tejszerű folyadék nyerhető belőle, de ez csak az esetek felében látható [17,18]. Éhgyomrú betegek (például a peri-vagy posztoperatív) vagy veleszületett chylothorax esetén a folyadékgyülem serosusnak vagy tisztának is tűnhet, sérülés után pedig vérrel festenyzett lehet, így nem kelt feltűnést.…”

Bilateral pleural effusions

“…Although chylothorax is typically classified as an exudative effusion, transudates have been described in patients with lymphoproliferative disease, following surgery, following exposure to radiation, in idiopathic cases and in patients with concomitant illness such as cardiac or renal failure. 6 The clinical presentation and past history of our patient did not fit with the other important cause of milky white effusion, pseudochylothorax. The most common conditions associated with pseudochylothorax are tuberculosis, rheumatoid pleurisy or pneumothorax.…”