Successful surgical treatment of primary chylopericardium in infant--a usefulness of intraoperative thoracic ductgraphy

Asymptomatic eight-year old girl was admitted to our surgical department from ophthalmology complaining enlarged heart size at the routine check before operation of strabismus. By pericardiocentesis it was confirmed that pericardial effusion was chyle biochemically and microscopically. In spite of several medical trials (i.e. diuretics, pericardial drainage, complete starvation with parenteral nutrition), copious amount of chyle discharge, measured 180 ml per day, couldn't be controlled. Mediastinal mass lesion and thoracic duct anomaly were excluded by both thoracic CT and lymphangiography, and primary chylopericardium without thoracic duct anomalies was suspected preoperatively. The diagnosis of primary pericardium was confirmed by intraoperative thoracic ductography which visualized thoracic duct and it's tributaries more clear than that of preoperative lymphangiography. Low thoracic duct ligation with resection of duct 55 mm in length and fenestration of the pericardium through right thoracotomy was successfully carried out. She was discharged on 8th day after surgery without any problems. She is doing well 7 months postoperation after discharge with reduced heart size and returns to normal activity. We concluded that intraoperative thoracic ductography had some advantages in terms of more clear visualization of thoracic duct anastomosis, precise diagnosis of etiology and choice of surgical options.