Spontaneous idiopathic chylothorax in adults.

hylothorax refers to the presence of chyle in the pleural cavity as a result of thoracic duct disruption. It is either spontaneous or traumatic. Typically, it appears as a milky, opalescent odorless fluid, rich in triglycerides. Herein, 2 cases of spontaneous idiopathic chylothorax are reported, with a brief review of the literature. A 37-year-old Saudi man, who was admitted for investigation of a left basal opacity that was detected during medical fitness screening. He reported nocturnal episodes of dry cough and dyspnea with spontaneous resolution, however, he denied any medical treatment. On examination vital signs were within normal limits. There were old cautery scars over the right upper quadrant of the abdomen. Chest examination demonstrated signs of a left-sided pleural effusion. Chest radiography showed a left basal homogenous opacity suggestive of pleural effusion and right upper lobe linear shadow suggestive of azygus fissures (Figure 1). Blood investigations including complete blood count (CBC), erythrocyte sedimentation rate (ESR), liver and renal function tests were all within normal limits. Thoracentesis yielded 800 ml of a pinkish milky fluid, its analysis confirmed the presence of chyle with high triglycerides and low cholesterol level (Table 1). Cytology of pleural fluid revealed lymphocyte predominance, negative for malignant cells. Mantoux test was carried out and direct smear and culture for acid fast bacilli were negative. C Clinical Note