A novel therapeutic strategy for the management of idiopathic chylopericardium and chylothorax

Chylopericardium in adults: A literature review over the past decade (1996–2006)

“…Time from onset of symptoms to diagnosis showed wide variation ranging from several years (13 years 19 in a patient who was incidentally discovered to have an enlarged heart and remained asymptomatic and 12 years 15 in a patient whose condition also was discovered incidentally and who refused pericardiocentesis) to acute presentations with tamponade. 20,21 The commonest causes of chylopericardium over the past decade were as follows: idiopathic (56%), 3,[10][11][12][13][14][15]19,20,[22][23][24][25][26][27][28][29][30][31] postoperative (9%) (viz, mitral valve replacement [6%], 1,4 coronary artery surgery [3%], 5 and orthotopic heart transplantation [3%] 6 ), malignant disease of the lymphatic system or other mediastinal neoplasms (6%) including mediastinal lymphangioma (3%) 32 and mediastinal dysgerminoma (3%), 9 signet ring cell carcinoma (3%), 7 Gorham syndrome (3%), 8 blunt trauma (3%), 28 mediastinal lymphangiectasis (3%), 3 vein thrombosis (3%), 17 endovascular treatment of superior vena cava syndrome (3%), 33 and tuberculosis (3%). 34 Abnormalities of the lymphatic system 22 and mediastinal lymphangiectasis 3 causing chyloperi-cardial effusions were referred to as idiopathic causes.…”

“…who have severe shortness of breath and tamponade 1,5,17,21,23,32 receive therapeutic and diagnostic pericardiocentesis. Many diagnostic modalities have been described, including (1) observation of Sudan III dye distribution into the pericardial cavity after oral intake of Sudan III dye, 20 (2) lymphangioscintigraphy, 14,23 (3) lymphangiography, 19 and (4) evaluation of chest radioactivity after an oral dose of 131 I-triolein. 20 All of these methods are used to ascertain the cause of the chylous pericardial effusion.…”

“…Conservative management was prescribed in 28 (84.84%) patients and consisted of pericardiocentesis alone (27%), 12,19,20,25,28,29,33 pericardiocentesis followed by medium chain triglycerides diet (6%) 23,34 and total parenteral nutrition (12%), 1,6,22,24 pericardiocentesis followed by total parenteral nutrition and external beam radiation (3%), 8 pericardiocentesis only followed by total parenteral nutrition (6%), 5,17 pericardiocentesis followed by vena caval revascularization (3%), 33 and diagnostic nontherapeutic pericardiocentesis followed by total parenteral nutrition (9%), 4,9,21 low fat diet (6%), 7,18 or medium chain triglyceride diet (9%). 3,14,26 In one patient conservative therapy was not described (3%).…”

“…10 Surgery was performed in 21 patients (57.57%), consisting of open thoracotomy in 7 patients (33.33%) 9,11,12,15,17,18,21,31 or video-assisted thoracoscopic surgery (VATS) in 10 patients (47.6%) 6,10,13,22,25,[28][29][30]32 with subsequent thoracic duct ligation and creation of a pericardial window. One case (4.7%) 19 consisted of thoracotomy and laparotomy with lymphovenous anastomosis between the thoracic duct and left renal vein. Another case (4.7%) consisted of pleuropericardial window and tumor resection.…”

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

“…: computed tomography or magnetic nuclear resonance), to rule out lymphatic obstruction secondary to mediastinal masses. Oral administration of Sudan III dye with an assessment of its distribution inside the pericardial space [26], lymphangioscintigraphy [21], lymphangiography [28] and thoracic radionuclide imaging after oral administration of one oral dose of 131 I-triolein [26,29] and marked erythrocytes [20] have been described.…”