Pseudochylothorax: An underdiagnosed entity


Case history

We are presenting a case of pleural effusion with presence of cholesterol crystals, known as pseudochylothorax or chyliform effusion. Patient was a 56 years old male and a known case of tuberculosis and ischemic heart disease. He took complete anti tubercular treatment one year back. Now the patient presented with shortness of breath. Ultrasonography revealed left sided mild pleural effusion with underlying collapse of lung. Multiple lymph node were also noted in bilateral cervical region largest measuring 1.3x1cm and showing loss of corticomedullary differentiation. Pleural tap was performed and 200 ml of pleural fluid was obtained and sent for Biochemistry and Cytopathology examination. Biochemistry revealed pleural fluid protein of 4.4 g%, fluid sugar 22 mg/dl and ADA level of 61.55. Grossly the fluid was thick pus-like. Microscopy of leishman stained smears prepared from pleural fluid revealed numerous cholesterol crystals with their typical rectangular plate like morphology, some of them having indented edges alongwith presence of some degenerated inflammatory cells. However acid fast bacilli could not be demonstrated with Ziehl Neelsen staining using 20% sulphuric acid. But other investigations including fine needle aspiration cytology of patient's lymph nodes suggested that he was having active tuberculosis


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Best Regards
Sarah Jhonson
Managing Editor
International Journal of Case Reports