Respiratory Distress in a Preterm Neonate Due to a Milky Pleural Effusion

Chylothorax is a rare presentation defined as presence of chyle in the pleural space due to leakage from thoracic duct or its tributaries following damage or blockage. It contains cholesterol, triglycerides, chylomicrons and lymphocytes in large amounts. Main clinical manifestations depend on the rate of chyle leakage resulting in respiratory compromise. A neonate born at 25-weeks of gestation (665g) was ventilated due to respiratory distress at birth and surfactant deficient lung disease. She was started on treatment for presumed sepsis. Her chest X-rays revealed obliterated right costophrenic angle indicating a pleural effusion which prompted thoracentesis due to frequent desaturations. Interestingly, pleural fluid was milky in appearance and biochemical and cytological analysis revealed high triglyceride level (57mg/dL), low cholesterol level (