Pleural fluid in chylothorax typically has which features?

Pleural fluid in chylothorax typically has which features?

• A. Milky appearance with elevated triglycerides
• B. Clear appearance with low protein
• C. Hemorrhagic with malignant cells
• D. Purulent with bacteria

Answer: (A)

Chylothorax occurs when lymphatic fluid rich in dietary fats leaks into the pleural space, so the fluid is milky and rich in triglycerides. The diagnostic clue is a high triglyceride level in the pleural fluid (typically >110 mg/dL) with the presence of chylomicrons on lipoprotein analysis. This reflects chyle containing dietary fats transported via the thoracic duct. In contrast, clear, low-protein fluid suggests a simple transudate, purulent fluid points to empyema with bacteria, and hemorrhagic fluid with malignant cells indicates a malignant effusion. Thus, the milky appearance with elevated triglycerides best characterizes chylothorax.

Chylothorax occurs when lymphatic fluid rich in dietary fats leaks into the pleural space, so the fluid is milky and rich in triglycerides. The diagnostic clue is a high triglyceride level in the pleural fluid (typically >110 mg/dL) with the presence of chylomicrons on lipoprotein analysis. This reflects chyle containing dietary fats transported via the thoracic duct. In contrast, clear, low-protein fluid suggests a simple transudate, purulent fluid points to empyema with bacteria, and hemorrhagic fluid with malignant cells indicates a malignant effusion. Thus, the milky appearance with elevated triglycerides best characterizes chylothorax.