Diagnostic Predicament of a Case of Spontaneous Transudative Chylothorax

Chylothorax is defined as presence of chyle in the pleural space. Typically, chylous effusion is exudative in nature. Transudative chylothorax is a very rare entity and is attributed to liver cirrhosis, nephrotic syndrome, SVC thrombosis, congestive heart failure and constrictive pericarditis. A 62-year-old female presented with chylothorax and a past history of mitral stenosis and left ventricular failure. On further evaluation she was found to have transudative chylothorax most likely due to congestive cardiac failure. She was treated with low fat diet, repeated thoracocentesis and diuretics. So far, only two cases of transudative chylothorax caused by congestive cardiac failure due to mitral stenosis have been reported in literature.