Presentation of case
Parameter | Patient data | Common results in chylothorax | |
---|---|---|---|
Leukocytes | Total (per µL) | 7377 | >400 |
Lymphocytes (%) | 76 | >50 | |
Total protein (g/dL) | 4.6 | 2–4 | |
Lactate dehydrogenase (U/L) | 185 | 70–200 | |
Glucose (mg/dL) | 96 | 80–130 | |
Cholesterol (mg/dL) | 143 | <200 | |
Triglycerides (mg/dL) | 3959 | >110a (diagnostic criteria) | |
pH | 7.37 | 7.35–7.50 |
Differential diagnosis
Appearance of fluid | Test indicated | Interpretation |
---|---|---|
Cloudy or turbid Turbid supernatant | Centrifugation Triglyceride levels | Turbid supernatant → high lipid levels >110 mg/dL → chylothorax >50 mg/dL but ≤110 mg/dL → obtain lipoprotein analysis Presence of chylomicrons → chylothorax ≤50 mg/dL and cholesterol >250 mg/dL → pseudochylothorax |
Bloody | Hematocrit | <1% → non-significant 1–20% → cancer, pulmonary embolism, trauma >50% of peripheral hematocrit: hemothorax |
Putrid odor | Stain and culture | Infection |
Malignancy | Lymphoma, chronic lymphocytic leukemia Lung cancer Metastatic disease |
Traumatic | Surgery for congenital heart disease, cardiovascular surgery (e.g. aortic procedures, coronary artery bypass graft surgery, valve replacement), esophagectomy, resection for lung cancer, lung transplantation, resection of mediastinal mass (e.g. neuronal tumor, thymoma, neuroblastoma, cystic hygroma, ganglioneuroma, metastatic tonsillar carcinoma), mediastinoscopy and lymphadenectomy, spinal surgery, central line placement, pacemaker implantation (via subclavian vein), embolization procedure for pulmonary arteriovenous malformation, partial hepatectomy, blunt chest trauma and other external injury |
Miscellaneous disorders | Sarcoidosis, tuberous sclerosis, pulmonary lymphangioleiomyomatosis, congestive heart failure, Kaposi sarcoma, radiation therapy of the mediastinum, (Granulomatous) Infections: tuberculosis, histoplasmosis, filariasis Subclavian venous thrombosis Congenital or acquired lymphatic disorders: Gorham’s disease, Milroy disease, congenital lymphatic hypoplasia Various lymphatic diseases: lymphangiomatosis, yellow nail syndrome, lymphangioma, thoracic duct cyst Secondary to chylous ascites (due to e.g. alcoholic or cryptogenic cirrhosis, hepatitis C infection, primary biliary cholangitis, primary sclerosing cholangitis, cholangiocarcinoma, pancreatic carcinoma) |
Idiopathic | Congenital (neonatal) Cases with no clear cause |