cholesterol pleural effusion

 Q: Cholesterol pleural effusion should always be read in conjunction with serum cholesterol level? 

A) True

B) False

Answer: B

Serum cholesterol is usually not elevated in cholesterol pleural effusions. There is no correlation. 

High cholesterol level in pleural effusion is called cholesterol pleural effusion. The other names used are chyliform effusion or pseudochylothorax. 

Note: Cholesterol effusion is not chylothorax. 

Cholestol pleural effusion occurs due to chronic inflammation. The two most common causes are Mycobacterium tuberculosis and rheumatoid arthritis. 

Cholestrol pleural effusion occurs during a chronic inflammatory situation where lysis of RBCs and neutrophils releases cholesterol and lipid constituents from degenerating cell membranes. Also, contributing phenomenon is the accumulation of serum lipids bound to low-density lipoproteins (LDLs) in pleural space during inflammation.

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References:

1. Huggins JT. Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med 2010; 31:743. 

2. Lama A, Ferreiro L, Toubes ME, et al. Characteristics of patients with pseudochylothorax-a systematic review. J Thorac Dis 2016; 8:2093. 

3. Hamm H, Pfalzer B, Fabel H. Lipoprotein analysis in a chyliform pleural effusion: implications for pathogenesis and diagnosis. Respiration 1991; 58:294. 

4. Prakash, UBS. Chylothorax and pseudochylothorax. Eur Respir Mon 2002; 7:249.