Byoung Chul Cho, et al. Fig. 1. Initial chest X-ray showing cardiomegaly. protein 5.0 g/dL, and LDH 234 IU/L. WBCs and RBCs were uncountable due to cell clumping. Routine bacterial and tuberculous cultures were subsequently reported as negative, as was the cytological examination, and the adenosine deaminase level was 15.5 U/L. Considering these clinical and laboratory findings, the initial clinical impression was of nonspecific chronic pericarditis with effusion. We did not diagnose chyloperi- cardium because we overlooked the clue offered by the color of the pericardial fluid. After peri- cardiocentesis, follow-up echocardiography re- vealed that minimal pericardial effusion re- mained. She was regularly followed up at our out- patient clinic after discharge. However, echo- cardiography one month later revealed a large amount of pericardial effusion without evidence of hemodynamic compromise (Fig. 2), and she was readmitted to our hospital for further evalua- tion. The patient, who was afebrile on admission, complained only of mild substernal discomfort. Her blood pressure was 90/60 mmHg and pulse rate 72 beats per minute. On physical examination neck veins were distended and peripheral pulses were normal. Her breathing sound was clear without rale, though heart sounds were slightly decreased and pericardial friction rub was inau- dible. The chest X-ray showed marked enlarge- ment of the cardiac shadow with a globar shape, and an electrocardiogram demonstrated a sinus rhythm, with low voltage QRS complexes in the Yonsei Med J Vol. 46, No. 3, 2005 Fig. 2. Echocardiography showing a large amount of per- icardial effusion. Fig. 3. Pericardial fluid showing its milky-yellowish ap- pearance. precordial leads. The laboratory examination showed; white cell count 7,740/mm3, hemoglobin 13.0 mg/dL, hematocrit 39%, and platelets 238,000/mm3. The ESR was 17 mm/hr and CRP 6.7 mg/dL. Blood chemistry revealed; BUN 12.9 mg/dL, creatinine 0.6 mg/dL, total protein 7.0 g/ dL, albumin 4.7 g/dL, AST/ALT 21/17 IU/L, total cholesterol 196 mg/dL, triglyceride 111 mg/dL, HDL-cholesterol 46 mg/dL, and LDL cholesterol 138 mg/dL. Urinalysis was normal. Antinuclear antibody and anti-viral antibodies including HIV were all negative. β2-microglobulin and CEA