Chylothorax in cirrhosis of the liver: analysis of its frequency and clinical characteristics.
OBJECTIVE
To ascertain the frequency and to describe the clinical and biochemical features of cirrhotic chylothorax.


METHODS
A descriptive clinical study.


METHODS
A community teaching hospital.


METHODS
Since November 1989 to October 1995, 809 patients with pleural effusions were studied by thoracentesis. Pleural effusions with a concentration of triglycerides higher than 110 mg/dL, a pleural fluid to serum triglyceride ratio higher than 1, and a pleural fluid to serum cholesterol ratio lower than 1 were considered chylothorax.


RESULTS
Twenty-four patients had pleural effusions that complied with all three aforementioned biochemical conditions. Five of these 24 patients (20%), were found to have liver cirrhosis as the main cause of chylothorax and in 3 of them, an abdominal source of the effusion could be demonstrated by intraperitoneal injection of a radioisotope (99mTc-sulfur colloid). The cirrhotic chylous effusions had significantly lower (p<0.005) protein (median, 1.7; range, 1.4 to 2.7 g/dL), lactate dehydrogenase (LDH) (median, 96; range, 77 to 138 IU/L), and cholesterol (median, 25; range, 22 to 64 mg/dL) levels than chylous effusions resulting from other causes (protein: median, 4.1; range, 1.7 to 6.8 g/dL; LDH: median, 351; range, 140 to 8,600 IU/L; and cholesterol: median, 87; range, 38 to 160 mg/dL). Cirrhotic chylothorax was always a transudate according to Light's criteria.


CONCLUSIONS
Chylothorax is a rare and apparently underappreciated manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. Its uniform biochemical characteristics can facilitate its separation from chylous effusions of different etiology, therefore avoiding potentially harmful diagnostic and therapeutic procedures.
Servicios de Neumología y Análisis Clínicos, Hospital General Universitario de Alicante, Spain.
S
S
Romero
C
C
Martín
L
L
Hernandez
J
J
Verdu
C
C
Trigo
M
M
Perez-Mateo
L
L
Alemany
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000378:metabolism / Q000473:pathology; D002784:Cholesterol / Q000032:analysis / Q000097:blood; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007274:Injections, Intraperitoneal; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010996:Pleural Effusion / Q000737:chemistry / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D011506:Proteins / Q000032:analysis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage; D014280:Triglycerides / Q000032:analysis / Q000097:blood
D011506:Proteins; D019275:Radiopharmaceuticals; D014280:Triglycerides; D013671:Technetium Tc 99m Sulfur Colloid; D002784:Cholesterol; D007770:L-Lactate Dehydrogenase