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Pseudochylothorax Without Pleural Thickening: Time to Reconsider Pathogenesis?

John M. Wrightson, MA; Andrew E. Stanton, MD; Nicholas A. Maskell, DM; Robert J. O. Davies, DM; Y. C. Gary Lee, PhD
Author and Funding Information

Affiliations: From the Oxford Pleural Unit (Drs. Wrightson, Stanton, Davies, and Lee), Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK; the North Bristol Lung Centre (Dr. Maskell), Southmead Hospital, Bristol, UK; the NIHR Oxford Biomedical Research Centre (Dr. Davies), University of Oxford, Oxford, UK; and the Centre for Respiratory Research (Dr. Lee), University College London, UK.

Correspondence to: Y. C. Gary Lee, PhD, University Department of Medicine and Lung Institute of Western Australia, University of Western Australia, Perth, WA 6009, Australia; e-mail: gary.lee@uwa.edu.au


This research was supported by the NIHR Oxford Biomedical Research Centre, UK (Dr. Davies), Medical Research Council, UK, and National Health & Medical Research Council, Australia (Dr. Lee), Department of Health & Higher Education Funding Council for England (HEFCE), Senior Clinical Lecturer awards (Drs. Maskell and Lee), and NIHR Academic Clinic Fellow programme, UK (Dr. Wrightson).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):1144-1147. doi:10.1378/chest.09-0445
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Pseudochylothorax (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion that is commonly associated with chronic inflammatory disorders such as tuberculosis or rheumatoid arthritis. Until now, there were only 15 published cases of arthritis-associated pseudochylothorax in the English language literature. Previous literature has suggested that pleural fluid cholesterol enrichment occurs in the context of grossly thickened (fibrotic) pleura over a prolonged period, usually > 5 years. We present six well-characterized cases of arthritis-associated pseudochylothorax, each notable due to their minimal pleural thickening. The median duration of symptoms (or arthritis, in the case of asymptomatic effusions) was 15 months. Such findings cast significant doubt on the conventional concepts of the pathogenesis of rheumatoid-associated pseudochylothorax. Clinicians should consider pseudochylothorax even in short-duration nonfibrotic pleural effusions.

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