The presence of triglycerides in the pleural fluid, above 110 mg/dl, is suggestive of chylothorax and the demonstration of chylomicrons in the fluid establishes the diagnosis of chylothorax. Triglyceride levels, above 110 mg/dl, are also seen in pseudochylothorax, which occurs in patients with long standing pleural effusion with thickened pleura. Little is known about triglycerides in pleural fluid in acute parapneumonic effusion and empyema. Pleural fluid from four patients (aged 3 - 7 years, mean 4 years), who were admitted to Winthrop-University Hospital with the diagnosis of parapneumonic effusion, was obtained by thoracentesis, and was evaluated for microbiological and biochemical parameters (data summarized in table below). All the patients were on antibiotics before admission. Latex agglutination tests were performed on the pleural fluid for the detection of bacterial antigens, and ELISA method was used to evaluate the serum for mycoplasma antibodies. Serum triglycerides were in the normal range in all patients. The patient with the triglyceride level of 383 mg/dl in the pleural fluid subsequently developed bronchopleural fistula and the remainder recovered uneventfully. These data suggest that pleural fluid triglycerides are in the chyliform range in acute bacterial parapneumonic effusion and empyema, and higher levels may indicate severity of the disease process.

Table 1 No caption available.
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