UpToDate - Chylothorax

Question 1

Is fever and chest pain common with chylothorax presentation?

Answer 1

No. It does not cause an inflammatory response.

Question 2

What are séquela of chylothorax?

Answer 2

Volume loss.
Protein and fat loss leading to malnutrition.
Protein loss leading to IG deficiency leading to immunodeficiency.
Fat loss leading to ADEK vitamin deficiency.

Question 3

What is a séquela of chylothorax in a patient being treated with amiodarone or digoxin for atrial fibrillation?

Answer 3

Uncontrolled AF. Digoxin and amiodarone are carried in chyle.

Question 4

Is a chylothorax often infected?

Answer 4

Usually not. There is a predominance of lymphocytes, which contributes to its sterility. That said, general infection rates rise do to a lack of these factors in the blood stream.

Question 5

What are the pleural fluid tests and cutoffs associated with chylothorax?

Answer 5

Exudative.
Lytes, protein, and glucose should be similar to plasma. LDH is low.
Triglycerides are >110. Cholesterol <200 (>200 suggests cholesterol effusion).
Lymphocytes >70% of total nucleated cell count.

Question 6

What if the triglyceride count in a suspected chylothorax is b/w 50 and 110?

Answer 6

Get lipoprotein electrophoresis to find chylomicrons.
Other tests: Sudan III staining to find fat globules.