Diagnostic value of pleural cholesterol in differentiating exudative and transudative pleural effusion

Gautam, Santosh; Kc, Shiva Raj; Bhattarai, Binita; K.C., Geetika; Adhikari, Gauri; Gyawali, Purnima; Rijal, Keshab; Sijapati, Milesh Jung

doi:10.1016/j.amsu.2022.104479

Cited by 2 publications

(4 citation statements)

References 20 publications

(21 reference statements)

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“…Pleural effusions can also be called as exudative if they have pleural fluid cholesterol level of greater than 45 mg/dL. 12 Our patient has pleural fluid cholesterol level of 58 mg/dL, as such can be classified as exudative.…”

Section: Discussionmentioning

confidence: 85%

“…9,11 Light's criteria, Heffner's criteria, and pleural cholesterol levels can be used to classify pleural effusion as exudative or transudative. 12 As per Light's criteria, pleural effusion is considered exudative if it meets at least 1 of the following criteria: 13 -a pleural fluid protein to serum protein ratio >0.5, -a pleural fluid LDH to serum LDH ratio >0.6, or -a pleural fluid total LDH greater than two-thirds the upper limit of normal serum LDH.…”

Section: Discussionmentioning

confidence: 99%

“…-pleural fluid protein >2.9 g/dL, -pleural fluid cholesterol >45 mg/dL, or -pleural LDH greater than two-thirds the upper limit of normal serum LDH. 12 According to this criterion, this effusion can be classified as exudative. Heffner's criteria have the advantage of using only pleural effusions investigations to classify the effusions as transudative or exudative whereas Light's criteria also require blood investigations.…”

Section: Discussionmentioning

confidence: 99%

“…Light’s criteria, Heffner’s criteria, and pleural cholesterol levels can be used to classify pleural effusion as exudative or transudative. 12 …”

Section: Discussionmentioning

confidence: 99%

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Chylothorax in the Setting of Lung Malignancy

Vangara,

Haroon,

Kalafatis

et al. 2023

Journal of Investigative Medicine High Impact Case Reports

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Chylothorax refers to chyle within the pleural space, which frequently arises from an interruption in the thoracic duct or because of reduced lymphatic drainage. Pleural fluid that is white/milky in appearance, with a triglyceride concentration of greater than 110 mg/dL, strongly supports the diagnosis of chylothorax. Chylothorax is nearly always exudative. Transudative chylothorax is extremely rare and typically presents due to a secondary cause, such as liver cirrhosis, nephrotic syndrome, or congestive heart failure. We present a case of chylothorax that occurs in the setting of lung adenocarcinoma. A 65-year-old African American man with a past medical history of metastatic right lung adenocarcinoma presented with dyspnea and palpitations. He denied fever, orthopnea, and paroxysmal nocturnal dyspnea. Therapeutic drainage of the left pleural effusion resulted in 650 mL of milky-white fluid. Pleural fluid analysis demonstrated a triglyceride concentration of 520 mg/dL, a pleural/serum protein ratio of 0.41, a pleural/serum lactate dehydrogenase (LDH) ratio of 0.26, a total pleural LDH of 127 IU/L, and a cholesterol level of 58 mg/dL. This effusion can be classified as transudative as per Light’s criteria and exudative as per Heffner’s and pleural cholesterol criteria. A subsequent pleural fluid cytology found malignant cells consistent with lung adenocarcinoma. Malignancy is the most common cause of nontraumatic, exudative chylothorax. Light’s criteria misinterpret about 25% of transudative effusions as exudative. Therefore, to minimize this error, a combination of the 3-criterial consideration is ideal.

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Section: Discussionmentioning

confidence: 85%