Rheumatoid pleural effusion presenting as pseudochylothorax in a patient without previous diagnosis of rheumatoid arthritis

Yokosuka, Tetsuya; Suda, Asako; Sugisaki, Midori; Suzuki, Manabu; Narato, Ritsuko; Saitô, Hitoshi; Enomoto, Tatsuji; Kobayashi, Toshiko; Nomura, Koichiro

doi:10.1016/j.rmcr.2013.09.003

Cited by 7 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sixty-two studies (2,3,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) involving 104 patients were selected for review (51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66). Figure 1 presents a flowchart for the complete breakdown in the identification of appropriate studies corresponding to isolated case reports and a retrospective series (35).…”

Section: Resultsmentioning

confidence: 99%

“…Pleural thickening was evaluated in 63 (60.6%) patients. In 13 (20.6%) cases, the thickening was minimum [five patients (49,55,58,63,64)], or non-existent [eight patients (50,53,55,66)]. In the 83 cases of patients with PE and descriptions of its appearance, 38 were milky, 33 cloudy, 7 opaque, 2 oily yellow (9,59), 1 bloody (33), 1 bloody-chylous (62), and 1 serous (23).…”

Section: Pementioning

confidence: 99%

See 1 more Smart Citation

Characteristics of patients with pseudochylothorax—a systematic review

Lama¹,

Ferreiro²,

Toubes³

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Pementioning

confidence: 99%

Characteristics of patients with pseudochylothorax—a systematic review

Lama¹,

Ferreiro²,

Toubes³

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…5 Since Weem's description in 1918, the medical literature has always emphasised that a hallmark of pseudochylothoraces is the presence of a grossly thickened (fibrotic) pleura, resulting from chronic intense pleuritis. 6 Yokosuka et al 7 reported similar case recently where parietal pleura showed slight thickening. It has been suggested that a pleural inflammatory process of at least five years is required for the development of a pseudochylothorax.…”

Section: Case Reportmentioning

confidence: 87%

Rheumatoid Arthritis Complicated by Pseudochylothorax Without Pleural Thickening: A Diagnostic Challenge for Clinicians

Agrawal¹,

Chandermani²,

Madaan³

et al. 2022

The Indian Journal of Chest Diseases and Allied Sciences

View full text Add to dashboard Cite

A 60-year-old female who was known to have rheumatoid arthritis for the preceding two-and-half years presented with difficulty in breathing associated with chest pain over the right hemithorax of two months duration. She was found to have a right-sided mild to moderate pleural effusion; there was no evidence of pleural thickening. The pleural fluid was pale yellow in appearance and diagnostic work-up confirmed it to be a pseudochylous pleural effusion. The present case highlights the rare occurrence of pseudochylothorax without pleural thickening as a complication of rheumatoid arthritis.

show abstract

“…In humans, PCE has been reported primarily as a consequence of tuberculosis or rheumatoid arthritis and less frequently as a consequence of paragonimiasis, echinococcosis, hydatidosis, yellow nail syndrome, Demons-Meigs syndrome, iatrogenesis, neoplasia, or trauma. 4,[10][11][12][13][14][15][16][17] Two case reports of cholesterol-rich effusions in dogs have been published but the effusions were either associated with a hemorrhagic component in a dog with concurrent marked hypercholesterolemia 18 or possible inadvertent aspiration of an ovarian cyst, 19 and did not meet the defining criteria of PCE. Another case of a dog with tuberculosis that had a milky opaque pleural effusion containing cholesterol crystals was reported but did not include any data regarding about cholesterol or triglycerides concentration or presence of cylomicrons.…”

Section: Commentsmentioning

confidence: 99%