Isolated chylopericardium. Diagnosis, hemodynamic studies and surgical treatment

Primary chylopericardium: A case report and literature review

Primary chylopericardium (CP) is a rare clinical condition in which chylous fluid containing high concentrations of triglyceride accumulates in the pericardial cavity. The present study reports a case of CP that was successfully treated by reconstruction surgery of thoracic duct. To improve the ability to diagnosis and treat this rare disease, the current study also systematically extracted 104 reported cases of primary or idiopathic CP from the past 60 years (January 1950 to December of 2015), and reviewed the clinical manifestation, etiology, diagnosis and treatment of these cases. The age at diagnosis varied between 6 weeks and 79 years with a mean age of 27.95±16.50 years. Asymptomatic patients accounted for 39.42% of cases, while the most common initial symptoms were dyspnea (44.23%) and coughing (10.58%). Jugular venous distention and distant heart sound was identified in 23 (22.12%) and 34 cases (32.69%), respectively. Cardiomegaly in X-ray scans was detected in the majority of patients (93.27%). In addition, lymphoscintigraphy and lymphangiography were helpful in identifying the source of chyle. Regarding the etiology, idiopathic cases accounted for 35.56% of the included cases in the present study. The most important cause of primary CP was abnormal connection or accumulation of lymph fluid in the pericardium (37.50%). Conservative therapy included low-fat or medium-chain triglyceride diet, as well as total parenteral nutrition. The majority of patients (71.2%) required surgery for definitive therapy, and thoracic duct ligation was the most preferred surgical procedure, performed in 44.23% of cases. Follow-up was reported in 64 cases, and all patients survived during the mean follow-up period of 12 months. Therefore, it is suggested that surgical management is the most successful treatment method and is associated with a favorable prognosis.

Primary Chylopericardium in a Heroin Addict

We describe a case of primary chylopericardium following acute Staphylococcus aureus endocarditis in a 33-year-old female heroin addict. The patient underwent surgical ligation of the thoracic duct after a low-fat diet failed to control the fluid accumulation. Three months postoperatively, the patient was in a good general condition and no pericardial effusion was observed.

Primary chylopericardium

To evaluate the surgical treatment of primary chylopericardium, 2 cases of primary chylopericardium are described and previous case reports are reviewed. Enhanced computed tomography combined with lymphangiography is a very reliable diagnostic tool for identifying abnormalities of the thoracic duct and its lymphatic channels connecting to the pericardium. When the course of the thoracic duct was identified exactly, ligation and resection of the thoracic duct with establishment of a pericardial window proved to be the most effective surgical procedure. Because the thoracic duct and the pericardium can be exposed easily, left thoracotomy seems to be the most preferable approach for the operation.

Primary chylopericardium: a review of the literature and an illustrated case

A report of a case of chylous pericardium and a review of previously reported cases are given. The specific diagnosis can be made with pericardiocentesis and analysis of the fluid which is milky in appearance and contains fat droplets microscopically. Thoracic duct obstruction with failure of adequate collateral drainage and resultant reflux of chylous lymph through lymphatics draining the heart and pericardium is proposed as a mechanism of development of this entity. Thoracic duct ligation and partial pericardectomy remain the preferred treatment for chylopericardium.

Lymphopericardium with hypoproteinemia, intestinal loss of protein, and congenital defects of the lymphatic system

In the case of the 19-year-old girl reported, lymphopericardium was associated with congenital abnormalities of the lymphatic system and with gastrointestinal loss of protein secondary to intestinal lymphangiectasia. No communication with the thoracic duct was found.