Distinguishing Chylous from Pseudochylous (Chyliform, Cholesterol) Effusions

Description

Thick, milky effusions may be due to either the leakage of chyle or the breakdown of cells over time. A chylous effusion: is due to leakage of chyle from the thoracic duct or other major lymphatic channel. A pseudochylous (cholesterol or chyliform) effusion typically is a chronic effusion that has been present for several years.

Both a chylous and cholesterol pleural effusion appear as a whitish, milky fluid.

Finding	Chylous Effusion	Pseudochylous Effusion
clinical	sudden onset	gradual onset
appearance	milky white; yellow-bloody	milky; greenish
chylomicrons	present	absent
triglycerides	usually > 110 mg/dL, sometimes 50-110 mg/dL	usually < 50 mg/dL, but some may be > 110 mg/dL
cholesterol crystals	absent	present
cholesterol content	low	high (> 200 mg/dL)
cell count	lymphocytosis	mixed cell reaction

where:

• Chylomicrons can be demonstrated on lipoprotein electropheresis.

A mixed effusion can have chylomicrons, triglycerides and a high cholesterol.

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Description

Specialty

ICD-10