CTICasesCholesterol Effusion (Pseudo-chylothorax) in Rheumatoid Arthritis
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Imaging findings
A pleural effusion with associated pleural thickening was present. Fluid sampled was milky white, initially suggesting a chylothorax, but analysis revealed numerous cholesterol crystals, confirming a cholesterol effusion (pseudo-chylothorax). Diffuse, dense, linear, plaque-like pleural calcification was also observed, which was interpreted as rheumatoid arthritis-related.
Key takeaways
A milky white pleural effusion is not always a chylothorax; it can be a cholesterol effusion (also known as pseudo-chylothorax or chyliform thorax) if cholesterol crystals are identified in the fluid. These effusions are associated with chronic pleural inflammation, notably in conditions like rheumatoid arthritis, and can be accompanied by calcified pleural plaques. Imaging findings alone may not be sufficient to distinguish it from chylothorax, requiring fluid analysis.
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