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Pseudochylothorax without pleural thickening: time to reconsider pathogenesis?

Authors
  • Wrightson, John M1
  • Stanton, Andrew E1
  • Maskell, Nicholas A2
  • Davies, Robert J O3
  • Lee, Y C Gary4
  • 1 Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.
  • 2 North Bristol Lung Centre, Southmead Hospital, Bristol, UK.
  • 3 Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
  • 4 Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; Centre for Respiratory Research, University College London, UK. Electronic address: [email protected]
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
October 2009
Volume
136
Issue
4
Pages
1144–1147
Identifiers
DOI: 10.1378/chest.09-0445
PMID: 19809057
Source
Medline
License
Unknown

Abstract

Pseudochylothorax (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion that is commonly associated with chronic inflammatory disorders such as tuberculosis or rheumatoid arthritis. Until now, there were only 15 published cases of arthritis-associated pseudochylothorax in the English language literature. Previous literature has suggested that pleural fluid cholesterol enrichment occurs in the context of grossly thickened (fibrotic) pleura over a prolonged period, usually > 5 years. We present six well-characterized cases of arthritis-associated pseudochylothorax, each notable due to their minimal pleural thickening. The median duration of symptoms (or arthritis, in the case of asymptomatic effusions) was 15 months. Such findings cast significant doubt on the conventional concepts of the pathogenesis of rheumatoid-associated pseudochylothorax. Clinicians should consider pseudochylothorax even in short-duration nonfibrotic pleural effusions.

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