Seminars in respiratory and critical care medicine
-
A chylothorax and a cholesterol pleural effusion represent the two forms of lipid effusions encountered. Traditionally, a lipid pleural effusion is characterized by the presence of milky fluid. Although these two effusions often share a similar pleural fluid appearance due to the high lipid concentration, they have major differences in the pathogenesis, clinical presentation, diagnosis, predisposing conditions, and management of these effusions. ⋯ Lung entrapment with thickened parietal and visceral pleural membranes is the typical radiographic findings of a cholesterol effusion. Most cases of cholesterol pleural effusions are attributed to tuberculous or rheumatoid pleurisy. Decortication is the mainstay of treatment for a cholesterol effusion in symptomatic patients with restrictive lung function.
-
Hepatic hydrothorax is the paradigmatic pleural effusion in liver cirrhosis. It is defined as a pleural effusion in a patient with portal hypertension and no cardiopulmonary disease. The estimated prevalence of this complication in patients with liver cirrhosis is 5 to 6%. ⋯ The more frequent bacteria involved are ENTEROBACTERIACEAE and gram-positive cocci. Antibiotic therapy is the cornerstone of therapy. This article reviews etiology, clinical manifestations, and therapy of these two complications of liver cirrhosis and portal hypertension.