ABSTRACT
This pleural fluid was drained from a patient after a motor vehicle accident. Similar pleural fluid may be associated with all of the following except:
a. Pleural fluid triglyceride level of more than 100 mg/dL b. Moderate congestive heart failure c. Lymphangiomyomatosis d. Thoracic duct obstruction e. Normal serum triglyceride level
• Almost 70% of dietary fat absorbed through the lacteal system is circulated through the lymphatic channels
• Chyle can be differentiated from other fluids by its high pleural triglyceride level (more than 100 mg/dL) in the setting of normal serum triglyceride levels
• High pleural fluid cholesterol level is not by itself indicative of a true chylous effusion
• Numerous causes for chylous effusions may be broadly categorized as:
Congenital (e.g., thoracic duct atresia) Traumatic (e.g., central line placement associated with subclavian vein thrombosis, after thoracic or esophageal surgery, penetrating injury)
Intrinsic (e.g., neoplasm, pulmonary lymphangiomatosis) Extrinsic (e.g., infections, such as tuberculosis)
• Lymphangiography may elucidate the thoracic duct anatomy and localize the site and extent of lymphatic obstruction
• Conservative management includes pleural fluid drainage and restriction of fat intake (medium-chain triglycerides are acceptable)
• Chylous effusions resulting from surgical complications are generally best managed surgically
