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胆固醇性胸腔积液的临床表现、诊断和处理

Author
John E Heffner, MD
Section Editor
Polly E Parsons, MD
Deputy Editor
Geraldine Finlay, MD
Translators
杨志仁, 副主任医师

引言

胆固醇性胸腔积液(也称乳糜样积液或假性乳糜胸)并不常见，通常见于持续5年以上的慢性胸膜炎症或感染的情况下，但更短的持续时间也有报道[1-3]。按照定义，胆固醇性胸腔积液含有高浓度胆固醇，赋予其特征性的浑浊的或牛奶样白色外观。尽管肉眼观察相似，但乳糜胸的牛奶样外观液体含有高浓度的甘油三酯，最常由胸导管破环或阻塞所致。

本专题将总结胆固醇性胸腔积液的诊断和处理。乳糜胸的病因、临床表现、诊断和处理，以及有关胸腔积液评估和处理的一般问题，都将单独讨论。 (参见“乳糜胸的病因、临床表现和诊断”和“胸腔积液的机制”和“成人胸腔积液的诊断性评估：初筛试验”和“成人胸腔积液的影像学检查”)

胆固醇性胸腔积液与乳糜胸

胆固醇性胸腔积液和乳糜胸都典型地具有牛奶样或乳白色外观，然而，它们的病因和治疗不同，因此区分它们十分重要。

●胆固醇性胸腔积液(也就是假乳糜胸或乳糜样积液)含有高浓度胆固醇。这些积液通常见于胸膜增厚和有时胸膜表面钙化的慢性胸膜炎症患者[4,5]，但也有报道见于无胸膜增厚的类风湿关节炎患者[2]。

●相比之下，乳糜胸更常见，含有高浓度的乳糜微粒形式的甘油三酯[1,6-8]。当胸导管或其他淋巴管道发生破环或阻塞，相应的淋巴液蓄积于胸膜腔时，则产生乳糜胸。 (参见“乳糜胸的病因、临床表现和诊断”)

                  

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-27.
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References
Top
  1. Garcia-Zamalloa A, Ruiz-Irastorza G, Aguayo FJ, Gurrutxaga N. Pseudochylothorax. Report of 2 cases and review of the literature. Medicine (Baltimore) 1999; 78:200.
  2. Wrightson JM, Stanton AE, Maskell NA, et al. Pseudochylothorax without pleural thickening: time to reconsider pathogenesis? Chest 2009; 136:1144.
  3. Nogueras C, Monteagudo M, Vila M, et al. Recent-onset tuberculous pleurisy presenting as pseudochylothorax. Am J Med 2002; 113:166.
  4. COE JE, AIKAWA JK. Cholesterol pleural effusion. Report of 2 cases studied with isotopic techniques and review of the world literature. Arch Intern Med 1961; 108:763.
  5. Hillerdal G. Chyliform (cholesterol) pleural effusion. Chest 1985; 88:426.
  6. Roy, PH, Carr, DT, Payne, WS. The problem of chylothorax. Mayo Clin Proc 1967; 42:457.
  7. Hillerdal G. Chylothorax and pseudochylothorax. Eur Respir J 1997; 10:1157.
  8. Agrawal V, Sahn SA. Lipid pleural effusions. Am J Med Sci 2008; 335:16.
  9. Hamm H, Pfalzer B, Fabel H. Lipoprotein analysis in a chyliform pleural effusion: implications for pathogenesis and diagnosis. Respiration 1991; 58:294.
  10. Balbir-Gurman A, Yigla M, Nahir AM, Braun-Moscovici Y. Rheumatoid pleural effusion. Semin Arthritis Rheum 2006; 35:368.
  11. Prakash, UBS. Chylothorax and pseudochylothorax. Eur Respir Mon 2002; 7:249.
  12. Thewjitcharoen Y, Poopitaya S. Paragonimiasis presenting with unilateral pseudochylothorax: case report and literature review. Scand J Infect Dis 2006; 38:386.
  13. Inoue Y, Kawaguchi T, Yoshida A, et al. Paragonimiasis miyazakii associated with bilateral pseudochylothorax. Intern Med 2000; 39:579.
  14. Ryu JH, Tomassetti S, Maldonado F. Update on uncommon pleural effusions. Respirology 2011; 16:238.
  15. Huggins JT. Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med 2010; 31:743.
  16. Carel RS, Schey G, Bruderman I. Chyliform pleural effusion. An unusual manifestation of hepatothoracic echinococcus cysts. Chest 1975; 68:598.
  17. Jujo T, Suda A, Yahaba M, et al. [Paragonimiasis Westermani associated with pseudochylothorax]. Nihon Kokyuki Gakkai Zasshi 2009; 47:890.
  18. Dainichi T, Nakahara T, Moroi Y, et al. A case of cutaneous paragonimiasis with pleural effusion. Int J Dermatol 2003; 42:699.
  19. Hooper C, Lee YC, Maskell N, BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65 Suppl 2:ii4.
  20. Shen PU, Blair JL. Cholesterol crystals causing falsely elevated automated cell count. Am J Clin Pathol 2006; 125:358.
  21. Minh VD, Engle P, Greenwood JR, et al. Pleural paragonimiasis in a Southeast Asia refugee. Am Rev Respir Dis 1981; 124:186.
  22. Hiratsuka T, Kodama T, Nakamura F. [Paragonimiasis westermani with repeated pleural effusion and diagnosed by detecting parasite eggs in pleural effusion]. Nihon Kokyuki Gakkai Zasshi 2007; 45:49.
  23. Johnson JR, Falk A, Iber C, Davies S. Paragonimiasis in the United States. A report of nine cases in Hmong immigrants. Chest 1982; 82:168.
  24. Song JW, Im JG, Goo JM, et al. Pseudochylous pleural effusion with fat-fluid levels: report of six cases. Radiology 2000; 216:478.
  25. Staats BA, Ellefson RD, Budahn LL, et al. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc 1980; 55:700.
  26. Tanijiri T, Yonezu S, Torii Y, et al. [Paragonimus westermani infection confirmed by the detection of Paragonimus ova in the sputum with bilateral pleural effusion]. Nihon Kokyuki Gakkai Zasshi 2009; 47:1131.
  27. Sassoon CS, Light RW. Chylothorax and pseudochylothorax. Clin Chest Med 1985; 6:163.
  28. GOLDMAN A, BURFORD TH. Cholesterol pleural effusion: A report of 3 cases with a cure by decortication. Dis Chest 1950; 18:586.