Milky Pleural Fluid

[摘要] A 90-year-old man was admitted for progressive dyspnea. His medical history included hypertension and chronic myeloid leukemia diagnosed 10 years before and treated with dasatinib. Physical examination revealed pitting edema of the legs and dullness to percussion in the right chest. Laboratory test results were clinically relevant for white blood cells 7.7 × 109/L (reference interval 4–10 × 109/L), platelets 162 × 109/L (150–400 × 109/L), hemoglobin 10.5 g/dL (13–18 g/dL), total protein 7.1 g/dL (6.3–8.1 g/dL), cholesterol 154 mg/dL (116–201 mg/dL) [3.99 mmol/L (3–5.2 mmol/L)], triglycerides 122 mg/dL (27–151 mg/dL) [1.38 mmol/L (0.3–1.71 mmol/L)], creatinine 192 μmol/L (45–90 μmol/L), and lactate dehydrogenase (LDH) activity 504 U/L (200–450 U/L). Chest radiograph showed a large right-sided pleural effusion; thoracentesis yielded milky pleural fluid with total protein 4.3 g/dL, LDH activity 291 U/L, cholesterol 66 mg/dL (1.7 mmol/L), and triglycerides 259 mg/dL (2.9 mmol/L). Bacterial cultures had no growth. After 12 h at 4 °C, the pleural fluid had a white ring at the top of the sample (Fig. 1).Fig. 1. The patient's pleural fluid after 12 hours at 4 °C.The first step in evaluation of a pleural effusion is to differentiate exudative and transudative effusions; this plays a key role in determining the etiology of the effusion. Both exudative and transudative fluids are characterized by translocation of excess fluid in the pleural cavity. The main difference is the functional integrity of the pleural membranes. Transudative effusions are defined by unaltered pleural membranes and characterized by increased hydrostatic pressure or decreased oncotic pressure. Exudative effusions are characterized by altered pleural membranes associated with increased permeability.The main etiologic …

[学科分类] 过敏症与临床免疫学