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Pleural Fluid Analysis in Chylous Pleural Effusion

Abstract

Objectives: Chyle is a noninflammatory, lymphocyte-predominant fluid that may cause a pleural effusion as a consequence of thoracic duct leakage into the pleural space. Although chyle is reported to have protein concentrations in the transudative range, chylous effusions are typically exudative by standard criteria. We hypothesized that chylous effusions from thoracic duct leak alone have low LDH concentrations due to the absence of inflammation and are lymphocyte-predominant, protein discordant exudates. Consequently, pleural effusions not meeting these criteria but with triglycerides >110 mg/dL or positive for chylomicrons should be associated with other diagnoses contributing to pleural fluid formation.

Study Design: Retrospective

Methods: The pleural fluid analyses of 876 consecutive thoracenteses were reviewed. All cases with a triglyceride concentration > 110 mg/dL or the presence of chylomicrons were retrieved. The effusions were then classified as transudates, concordant exudates, protein discordant exudates, LDH discordant exudates, and according to lymphocyte predominance (>50%). The causes of these pleural effusions were determined after the review of the medical record.

Results: Twenty-two pleural effusions had elevated triglyceride concentration and/or positive chylomicrons. Eleven effusions were lymphocyte-predominant, protein discordant exudates, two of these were associated with chylous ascites. The remaining effusions were transudates (n=7) or concordant exudates (n=4); all were associated with conditions known to cause pleural effusion apart from chyle leakage.

Conclusion: Chylous effusions caused solely by conditions known to cause chylothorax were lymphocyte-predominant, protein discordant exudates. Protein concentrations in the transudative range or elevated LDH concentrations were associated with a coexisting condition that may impact management of these chylous effusions.

Key Words: Chylothorax • chyle • chylous pleural effusion • thoracic duct • chylous ascites