(aka Cholesterol Pleurisy, Chyliform Effusion, Cholesterol Effusion)
Epidemiology
- xxxx
Etiology
- [[Rheumatoid Arthritis]]
- [[Tuberculosis]]
- Post-Therapeutic Pneumothorax
- Trauma with Hemothorax
Physiology
- Long-standing pleural fluid (usually >5 years), which is typically encapsulated in a area of thickened pleura -> concentration of cholesterol in the fluid
- Slow enlargement over time
Diagnosis
- CXR/Chest: necessary to define the anatomy
- Markedly thickened pleura (due to irritation of pleura)
- Pleural Fluid: usually thick, opalescent, whitish or coffee-colored (due to high fat content)
- Important Aspects of Thoracentesis:
- The pleural peel is often thick (and may be calcified) -> may make puncture difficult
- The walls around the fluid are stiff -> negative pressure can develop if forceful suction is applied (causing patient pain)
- Ethyl ether: does not result in clearing of fluid
- Centrifugation: cloudiness persists
- Cholesterol: always very high (>200 mg/dL)
- Triglyceride: can occur in some cases of pseudochylothorax (but this is not characteristic)
- Microscopy: cholesterol crystals can be seen (diagnostic)
[Hamm H, Pfalzer B, Fabel H. Lipoprotein analysis in a chyliform pleural effusion: implications for pathogenesis and diagnosis. Respiration 1991; 58: 294–300] - AFB Cultures: should always be sent
- Important Aspects of Thoracentesis:
Cllinical
- Symptoms of Pleural Effusion
- Complicating Infections:
- Reactivation [[Tuberculosis]]
- Aspergillosis
- Other Fungal Infections
- Complicating [[Bronchopleural Fistula]] or Pleurocutaenous Fistula
Treatment
- xxx
References
- ERJ May 1, 1997 vol. 10 no. 5 1157-1162
- Hamm H, Pfalzer B, Fabel H. Lipoprotein analysis in a chyliform pleural effusion: implications for pathogenesis and diagnosis. Respiration 1991; 58: 294–300