Isolated chylopericardium after cardiac surgery

Chylopericardium is a rare complication of cardiac surgery. It may be caused by a lesion in the thoracic duct or its tributaries or by thrombosis in the confluence of the jugular and left subclavian veins, obstructing the drainage of the thoracic duct. The treatment may be conservative or surgical, depending on the duration and on the volume of the effusion. We report the case of a 24-year-old female, who, in the late postoperative period of mitral valve replacement (bioprosthesis), was hospitalized with cardiac tamponade due to the presence of chylopericardium. The clinical findings and treatment performed are discussed.     

Massive primary chylopericardium in an infant

We report a case of massive spontaneous primary chylopericardium in a 2-month-old infant who was successfully treated with thoracic duct ligation and creation of a posterior pericardial window.     

Isolated chylopericardium due to lymphangiomatous dysplasia of the thymus

In this paper we present the case of an 18-year old asymptomaticwoman whose routine chest radiograph revealed an enlarged cardiacsilhouette which was caused by a chylopericardium due to a lymphangiomaof the thymus.     

A case of isolated primary chylopericardium.

Primary chylopericardium presented as radiographic cardiomegaly in an asymptomatic 19-year-old man. Normal findings at cardiac catheterisation and angiographic demonstration of cardiac displacement from the diaphragm suggested a collection of fluid below the heart which was confirmed by M and B mode ultrasound scanning. Thoracic blood pool isotope scanning indicated that the lumen was a pericardial effusion rather than a cyst. Lymphangiography did not indicate any direct lymphatic communication though a small pool of contrast appeared in the pericardium and the diagnosis of chylopericardium was confirmed by pericardiocentesis. Surgical treatment was undertaken after rapid reaccumulation of chyle and the patient remains well 6 months later.     

A case of isolated primary chylopericardium.

Primary chylopericardium presented as radiographic cardiomegaly in an asymptomatic 19-year-old man. Normal findings at cardiac catheterisation and angiographic demonstration of cardiac displacement from the diaphragm suggested a collection of fluid below the heart which was confirmed by M and B mode ultrasound scanning. Thoracic blood pool isotope scanning indicated that the lumen was a pericardial effusion rather than a cyst. Lymphangiography did not indicate any direct lymphatic communication though a small pool of contrast appeared in the pericardium and the diagnosis of chylopericardium was confirmed by pericardiocentesis. Surgical treatment was undertaken after rapid reaccumulation of chyle and the patient remains well 6 months later.     

Pedal Tc-99m phytate lymphoscintigraphy in primary chylopericardium

This paper describes a case of 65-year-old woman with primary chylopericardium. She received Tc-99m phytate lymphoscintigraphy after pericardial drainage and was managed with medium-chain triglycerides without surgical intervention. This was the first reported case of primary chylopericardium diagnosed with Tc-99m phytate lymphoscintigraphy.     

Primary chylopericardium

Primary chylopericardium is a rare entity. Here we describe a 36-year-old, asymptomatic male in whom pericardial effusion was detected by chest X-ray and echocardiography on routine health control. After pericardiocentesis that revealed the chylous nature of the fluid, partial pericardiectomy without duct ligation was carried out. In the follow-up period, there was no evidence of pericardial fluid on chest X-ray and echocardiography, at three months after the procedure.     

Isolated chylopericardium after intrapericardial procedures: possible role of inadvertent right efferent lymphatic trunk injury

Chylopericardium after an intrapericardial procedure is rare, and satisfactory explanations of its possible causes are lacking.Herein, we present 4 cases of chylopericardium that developed after intrapericardial surgery, and we review the literature.Our literature review revealed 29 cases of chylopericardium that complicated intrapericardial operations, to which we added our 4 cases for analysis. The 33 surgical procedures involved repair for congenital heart disease (n=21), valve surgery (n=5), coronary artery bypass grafting (n=6), and other (n=1). Causes were verified in 7 patients: small lymphatic injury in 3 and high venous pressure or venous thrombosis in 4. Of the 26 patients with chylopericardium of unknown origin, 15 had congenital heart disease. Ten of these 15 had chromosomal abnormalities, especially trisomy 21 (Down syndrome); these patients typically had increased lymphatic permeability, which raised the likelihood of chylopericardium. Five revascularizations for coronary artery disease required harvesting of the left internal thoracic artery for reconstruction, incurring a risk of damage to the drainage site of the right efferent lymphatic trunk. In addition, all 26 patients with chylopericardium of unknown origin underwent dissection of the ascending aorta and the main pulmonary artery, near the right efferent lymphatic trunk. Inadvertent injury to the trunk during the dissection would have increased the risk of chylopericardium. Accordingly, even though the overall incidence of chylopericardium during intrapericardial procedures is low, we recommend a meticulous dissection of the ascending aorta from the main pulmonary artery.     

Pedal (99m)Tc-sulfur colloid lymphoscintigraphy in primary isolated chylopericardium

Primary isolated chylopericardium is a rare disorder in which chylous fluid accumulates in the pericardial space. In this case report of a 61-year-old man with chylopericardium, pedal (99m)Tc-sulfur colloid (SC) lymphoscintigraphy was performed after emergent pericardiocentesis, and when there was a recurrent massive pericardial effusion. The results showed that (99m)Tc-SC lymphoscintigraphy can clearly reveal the lymphodynamics in patients with primary isolated chylopericardium. This noninvasive investigation is valuable and can be easily performed either before or after pericardiocentesis.