Sunday February 8, 2009


Case: 48 year old male presented to ER with Shortness of Breath. CXR showed massive left sided pleural effusion. ER physician inserted chest tube but to surprise white milky fluid get drained from chest. You made diagnosis of "Nontraumatic" Chylothorax. What are the 5 major causes of "Nontraumatic" Chylothorax?


Answer:

1. Lymphoma
2. cirrhosis,
3. tuberculosis,
4. sarcoidosis,
5. amyloidosis

Lymphoma is the most common cause of "Nontraumatic" Chylothorax, representing about 60% of all cases, with non-Hodgkin lymphoma more likely than Hodgkin lymphoma to cause a chylothorax. Trauma is the second leading cause of chylothorax (25%) including iatrogenic injury to the thoracic duct with thoracic procedures.

Pseudochylothorax: Chylothorax must be distinguished from pseudochylothorax, or cholesterol pleurisy, which results from accumulation of cholesterol crystals in a chronic existing effusion. The most common cause of pseudochylothorax is chronic rheumatoid pleurisy, followed by tuberculosis and poorly treated empyema.