Diagnostic Dilemma of Milky Yellow Pleural Effusion.

BACKGROUND

Chylothorax, a common complication post-lung cancer surgery, lacks standardized laboratory diagnostic criteria. Misdiagnosis remains prevalent due to variable pleural fluid appearance.

METHODS

We analyzed pleural fluid via biochemical tests, lipid profiling, and Sudan III staining. Ratios of effusion-to-serum triglycerides (P/S TG > 1) and cholesterol (P/S CHOL < 1) were applied to confirm chylous effusion.

RESULTS

The patient's pleural fluid exhibited milky yellow appearance, elevated TG (5.46 mmol/L), P/S TG ratio (3.62), and positive Sudan III staining. P/S CHOL ratio (0.43) and CHOL/TG (0.32) aligned with chylous criteria. Conservative management resolved the lymphatic leak.

CONCLUSIONS

Integrating TG/CHOL ratios with Sudan III staining enhances diagnostic accuracy for chylothorax, reducing false negatives in non-milky effusions.