Correct!
3. Triglycerides

The fluid has the characteristic appearance of a chylous effusion or chylothorax which results from an accumulation of chyle or lymph fluid in the pleural space. The appropriate test to diagnose a chylous effusion is a triglyceride level. Our patient’s triglyceride level was markedly elevated at 967 mg/dL (normal usually < 110). The adenosine deaminase (ADA) is a test for tuberculosis which is not routinely ordered in the US because of the low incidence of tuberculosis. The pleural fluid pH can be useful in the diagnosis including empyema where it is usually below 7.2. The patient’s course does not really fit with empyema but empyema on occasion can have the same milky appearance when it is packed with polymorphonuclear leukocytes.

Which of the following are true regarding chylous pleural effusions? (Click on the correct answer to proceed to the fourth of seven pages)

1. About half are secondary to trauma (surgical, penetrating trauma)
2. Chylous effusions are common after coronary bypass grafting but usually resolve
3. May be secondary to an obstruction of the thoracic duct or elevated venous pressures
4. 1 and 3
5. All of the above

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