Hilezopodobny effusion forming psevdohilotoraks , the Features rizuetsya accumulation of turbid or milky liquid color due to a high lipid content not associated with at stated failures thoracic duct. Some authors say that effusions containing cholesterol crystals are pseudochilous , and those that do not contain cholesterol crystals are chiles – like . Since this distinction has no practical significance, all nehileznye pleural effusions with high we call lipid holding hilezopodobnymi . Pseudochilothorax as chiles – like pleural effusion meeting etsya rare. For 1961 in the world literature only 99 cases of pseudochilothorax were recorded . Of 53 cases netravmati Cesky chylothorax with high lipid content was only 6 cases (11%) hilezopodobnogo pleural vypo that .
Pathogenesis
Pathogenesis hilezopodobnogo pleural effusion is not exactly of Westen . The majority of patients with hilezopodobnym Pleven eral effusion observed thickening and sometimes obyzvest appearance of the pleura as a result of long-term presence of pleural Foot effusion (for an average of 5 years). As a result, patho logical changes in the pleura cholesterol transport and Drew GIH lipids is slower than normal, which can lead to the accumulation of cholesterol in the pleural fluid . Origin of cholesterol and other lipids is not known, it is believed that they are formed as a result of degenerative tion erythrocyte and leukocyte in the pleural fluid . The majority of patients with hilezopodobnym pleural ful that disturbances in cholesterol metabolism is not observed as serum cholesterol within the normal range and there are no such signs of IU cholesterol tabolizma as xanthelasmatosis .
Some chyle-like pleural effusions contain cholesterol crystals. However, features which would be predicted that the pleural fluid will at sutstvovat cholesterol crystals were not found. For example, cholesterol crystals may be present in the pleural fluid with cholesterol below 150 mg / 100 ml, while they may not be in the pleural fluid in koto swarm cholesterol content exceeds 800 mg / 100 ml .
Clinical picture
Chyle-like pleural effusion is observed in patients with a long-existing effusion . Pleural you sweat becomes hilezopodobnym an average of 5 years, but by limiting cases it can be formed and within one second , yes. The basis of the formation of primary effusion are most often two reasons – rheumatoid pleurisy or tuberculosis . Particularly susceptible to hilezopodobnogo pleural Foot effusion patients who for tuberculosis creating whether artificial pneumothorax, and has developed atelectasis lay who contributed to the formation of pleural effusion. INR during GIH cases, the reasons for the formation of primary effusion remains undiagnosed . Recently, 3 cases of chyle-like pleural effusion caused by paragonimiasis have been described in the literature .
In many patients, the chiles-like pleural effusion does not, at least initially, give clinical symptoms. By Since visceral pleura is usually thickened, ventilation nye ability to easily reduced, and can usually watch Xia dyspnea. Chyle-like pleural effusions are usually unilateral.
Diagnostics
Diagnosing chyle-like pleural effusion is usually not difficult. If a patient with long-existing Pleven eral effusion, pleural fluid become cloudy or mo mammary color, there may be two other diagnosis, empyema or chylothorax . In cases of empyema after centrifugation, the supernatant is clear. Differentiation of chylothorax and Heel zopodobnogo pleural effusion is more complicated, but if in ointments ke taken from sediment, cholesterol crystals are found, it means that the patient hilezopodobny pleural effusion. Cholesterol crystals impart pleural fluid divided silky sheen. Microscopically, the crystals ho lesterina have a typical diamond shape (see. Fig. 43). Lack of cholesterol crystals does not serve as proof tion, it is not hilezopodobny pleural effusion. In a certain ryh cases hilezopodobnyh pleural effusions defined wish to set up high triglycerides (> 250 mg / 100 ml) , therefore this test can not be used in the diagnosis of chylothorax . If there is any doubt whether a given effusion is chyle or pseudochylous , then a test should be performed. adherence on lipoproteins, as chylomicrons comprise smiling only chylous pleural fluid 14, 17]. Differential rentsiatsiya chylothorax and psevdohilotoraksa usually difficult. Chylothorax is characterized by an acute course, while on surface of the pleura is not changed, while psevdohilotoraks is chronic, the pleura is thickened or obyzvestvlena .
Treatment
If a diagnosis of chiles-like pleural effusion is diagnosed , tuberculosis should be suspected. If the patient has in the past been registered tuberculosis, and he had not received anti tuberculosis treatment, it is recommended that treatment with isoniazid and rifampicin for 9 months. In the case of positive tion tuberculin test the patient should receive the same drugs, if he did not get them earlier or was not vaktsi nirovan.
Chronic pleural effusion itself does not cause concern, and such patients recurrent pleural Punk tion is probably not required. Repeated aspiration axes may falsely form or empyema bronchopleural SVR conductive . For such patients should be considered for Dekort katsii. If the patient has a decrease in exercise tolerance and there is reason to assume that the function -regional opportunities is not easily broken, then decortication can provide improvement of the patient and eliminating hilezopodobnogo pleural effusion .