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Pulmonary infarction — SCE Respiratory MCQ

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HardImagingPulmonary infarctionSCE Respiratory

A patient with longstanding rheumatoid pleuritis has a chronic milky effusion. Pleural triglyceride is 0.38 mmol/L, cholesterol is 6.4 mmol/L and microscopy shows plate-like cholesterol crystals. Which interpretation is correct?

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Correct answer: B — Pseudochylothorax from chronic pleural inflammation

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · C = shown as D · A = shown as E

E is correct. Pseudochylothorax is a cholesterol-rich effusion associated with longstanding pleural inflammation, classically tuberculosis or rheumatoid disease. Triglyceride below 0.56 mmol/L together with cholesterol above 5.18 mmol/L and cholesterol crystals is diagnostic. True chylothorax generally has triglyceride above 1.24 mmol/L or demonstrable chylomicrons and lower cholesterol. Appearance alone cannot diagnose pus or blood, and the lipid profile is not converted into malignant chylothorax by an arbitrary label.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC10944732/