Isolated chylopericardium. Diagnosis, hemodynamic studies and surgical treatment

The eighth clinical case of isolated idiopathic chylopericardium is reported, and the literature is reviewed. A 40 year old asymptomatic man with an enlarged cardiac silhouette of six years' duration had a pericardial effusion diagnosed by angiocardiography and injection of carbon dioxide. Pericardiocentesis revealed 1 L. of milky fluid, which had the composition of chyle, was ether-extractable, and had a lipid content of 1.3 gm.%. Right and left heart catheterization ruled out significant congenital or acquired heart disease and revealed an essentially normal hemodynamic profile at rest and a normal response to exercise. Intravenous ouabain was followed by a slight positive inotropic effect. The picture was that of a pure pericardial effusion without either constriction or myocardial disease.Pericardiocentesis was followed initially by reaccumulation of chyle and by a nonchylous pleural effusion. Later, both pericardial and pleural effusions were reabsorbed.No abnormalities of the thoracic lymphatics were seen by lymphangiography performed preoperatively as well as at operation. A right thoracotomy revealed a grossly normal thoracic duct and no evidence of abnormal lymphatic channels, tumor or inflammatory disease. The thoracic duct and adjacent small lymph nodes were normal histologically.Following ligation of the thoracic duct and the construction of a pleuropericardial window, the patient made an uneventful recovery. He returned to work and has remained asymptomatic and well for 17 months.