Chylothorax Diagnosis — FRCA Final MCQ

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ModerateIntensive Care MedicineChylothorax DiagnosisFRCA Final

A 40-year-old woman on the ICU has acute pancreatitis. She develops a pleural effusion requiring drainage. The fluid is milky white. Triglyceride level in the pleural fluid is 5.8 mmol/L. What type of effusion is this?

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Correct answer: A — Chylothorax

A milky white pleural effusion with elevated triglycerides (>1.24 mmol/L / >110 mg/dL) is diagnostic of chylothorax. This represents lymphatic fluid (chyle) leaking into the pleural space. In acute pancreatitis, the mechanism is disruption or inflammation of the thoracic duct by the pancreatic inflammatory process. Other causes include: thoracic surgery (oesophagectomy, cardiac surgery), lymphoma, and trauma. Management: drainage, reduction of chyle flow (fasting + TPN or medium-chain triglyceride diet), octreotide, and if persistent, thoracic duct ligation or embolisation.

Reference: BTS – 2023 – Pleural disease guidelines; ICS – 2023 – Pleural procedures