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Verma B, Kumar A, Verma N, Agrawal A, Yesilyaprak A, Furqan MM, Mahalwar G, Berglund F, Manna S, Schleicher M, Raeisi-Giglou P, Nasser M, Jabri A, Wang TKM, Klein AL. Clinical characteristics, evaluation and outcomes of chylopericardium: a systematic review. Heart 2023; 109:1281-1285. [PMID: 36702544 PMCID: PMC10423526 DOI: 10.1136/heartjnl-2022-321798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/16/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Chylopericardium (CPE) is a rare condition associated with accumulation of triglyceride-rich chylous fluid in the pericardial cavity. Due to minimal information on CPE within the literature, we conducted a systematic review of all published CPE cases to understand its clinical characteristics, management and outcomes. METHODS We performed a literature search and identified cases of patients with CPE from 1946 until May 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant articles for pooled analyses of clinical, diagnostic and outcome data. RESULTS A total of 95 articles with 98 patients were identified. Patient demographics demonstrated male predominance (55%), with a mean age of 37±15 years. Time from symptom onset to diagnosis was 5 (Q1 4.5, Q3 14) days, with 74% of patients symptomatic on presentation. Idiopathic CPE (60%) was the most common aetiology. Cardiac tamponade secondary to CPE was seen in 38% of cases. Pericardial fluid analysis was required in 94% of cases. Lymphangiography identified the leakage site in 59% of patients. Medical therapy (total parenteral nutrition, medium-chain triglycerides or octreotide) was undertaken in 63% of cases. In our cohort, 32% progressed towards surgical intervention. During a median follow-up of 180 (Q1 180, Q3 377) days, CPE recurred in 16% of cases. Of the patients with recurrence, 10% were rehospitalised. CONCLUSION CPE tends to develop in younger patients and may cause serious complications. Many patients fail medical therapy, thereby requiring surgical intervention. Although overall mortality is low, associated morbidities warrant close follow-up and possible reintervention and hospitalisations.
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Affiliation(s)
- Beni Verma
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Cardiovascuar Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ashwin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Nikita Verma
- Department of Medicine, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdullah Yesilyaprak
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Muhammad M Furqan
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gauranga Mahalwar
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Felix Berglund
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sayan Manna
- Mallinckrodt Institute Department of Radiology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Mary Schleicher
- EIectronic Library Services,Research Innovation and Education, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pejman Raeisi-Giglou
- Department of Cardiovascuar Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Mohamed Nasser
- Department of Cardiovascuar Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ahmad Jabri
- Department of Cardiovascuar Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Tom Kai Ming Wang
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases,Section of Cardiovascular Imaging,Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Parshin VD, Saliba MB, Anokhina VM, Bolotskaya AA, Kryuchkova KY, Parshin AV. [Surgery for chyloptysis]. Khirurgiia (Mosk) 2022:120-125. [PMID: 35593636 DOI: 10.17116/hirurgia2022051120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Chyloptysis is a rare disease characterized by formation of bronchial casts containing chyle and repeating bronchial tree branching. The authors report a 56-year-old woman with chyloptysis accompanied by cough and expectoration of milky bronchial casts, as well several episodes of asphyxia. Stages of diagnosis and successful treatment including thoracic duct ligation and skeletonization of the root of the left lung are described. The authors also analyze literature data on etiology, pathogenesis and feasibility of conservative and surgical treatment of these patients.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M B Saliba
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V M Anokhina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Bolotskaya
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K Yu Kryuchkova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Tang G. Vaginal discharge caused by lymphatic malformation identified by lymphoscintigraphy combined with T2-weighted magnetic resonance imaging. J Vasc Surg Cases Innov Tech 2020; 6:1-5. [PMID: 32025595 PMCID: PMC6997504 DOI: 10.1016/j.jvscit.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 10/10/2019] [Indexed: 11/05/2022] Open
Abstract
Prepubertal vaginal discharge is most commonly caused by vulvovaginitis and is rarely caused by lymphatic malformations, resulting in chylous vaginal discharge. The diagnosis of chylous vaginal discharge remains a challenge because of a knowledge gap. We describe a 12-year-old girl with intermittent vaginal discharge for 10 years. Although we found a high signal in the vagina on T2-weighted magnetic resonance imaging (MRI), the final diagnosis, vaginal lymphatic leakage, was established on lymphoscintigraphy. Lymphatic leakage in the vagina on lymphoscintigraphy was the key imaging feature of chylous vaginal discharge in this patient. Moreover, diffuse radioactivity was found in the abdomen and thorax on lymphoscintigraphy, which indicated the multiple cystic lymphatic malformations and intestinal lymphangiectasia combined with T2-weighted MRI. Thus, T2-weighted MRI could be used in combination with lymphoscintigraphy to simply identify chylous vaginal discharge.
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Kalra SS, Innabi A, Runnstrom M, Lascano J, Patel DC. Severe hypertriglyceridemia, acute pancreatitis and chyloptysis. QJM 2020; 113:47-48. [PMID: 31529077 DOI: 10.1093/qjmed/hcz236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- S S Kalra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - A Innabi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - M Runnstrom
- Division of Internal Medicine, Department of Medicine, Emory University, Atlanta, GA, USA
| | - J Lascano
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - D C Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
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