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Title: | Milky pleural effusion in a neonate and approach to investigating chylothorax |
Authors: | Senarathne, U.D. Rodrigo, R. Dayanath, B.K.T.P. |
Keywords: | neonatal intensive care |
Issue Date: | 2021 |
Publisher: | BMJ Publishing Group |
Citation: | BMJ Case Reports.2021; 14(9):e245576. |
Abstract: | Neonatal chylothorax is a rare presentation leading to significant respiratory distress, thus requiring timely diagnosis. A preterm neonate was resuscitated and ventilated, following which she clinically improved but subsequently developed respiratory distress with a right-sided pleural effusion. Interestingly, thoracentesis fluid appeared 'milky' with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24 mmol/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients. |
Description: | Indexed for MEDLINE. |
URI: | http://repository.kln.ac.lk/handle/123456789/23845 |
ISSN: | 1757-790X (Electronic) |
Appears in Collections: | Journal/Magazine Articles |
Files in This Item:
File | Description | Size | Format | |
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bcr-2021-245576.pdf | 839.78 kB | Adobe PDF | View/Open |
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