Chylopericardium Effusion in a Lac Alaotra Bamboo Lemur (Hapalemur alaotrensis)

Abstract

An 11-year-old female Hapalemur alaotrensis was evaluated following a history of dyspnea of 15 days’ duration. Thoracic radiography performed by the referring veterinarian revealed a large cardiac silhouette and dorsal deviation of the trachea. Heart sounds were muffled. Echocardiographic findings were indicative of severe pericardial effusion without cardiac tamponade. No pleural effusion was identified. A computed tomography (CT) exam confirmed the presence of severe pericardial effusion and allowed identification of a parenchymatous mediastinal lesion sited at the level of the left hemithorax. To delineate the thoracic duct, lymphoCT was also performed by injection of iodinated contrast medium in the perianal subcutaneous tissue. Pericardiocentesis yielded a considerable amount of effusion with chylous biochemical and cytological properties. A diagnosis of chylopericardium with absence of pleural effusion was made. Initially, the chylopericardium was managed conservatively with two centesis and oral treatment with prednisolone. Medical treatment did not result in complete resolution of effusion and clinical signs; therefore, subtotal pericardiectomy and thoracic duct ligation were recommended. After the second pericardiocentesis, the subject died and the pericardiectomy could not be performed. To the authors’ knowledge, this is the first report of the development of chylopericardium in a Hapalemur alaotrensis.

Chylothorax associated with pulmonary compressive atelectasis in an emperor tamarin (Saguinus imperator)

“…Dyspnea and death associated with respiratory insufficiency have been reported in other species due to pulmonary compression by the chyle accumulation 5,8 . In this emperor tamarin, respiratory insufficiency was the cause of death and a consequence to the lung compression by the chylothorax.…”

“…The chyle accumulation caused severe lung compression which evolved to compressive pulmonary atelectasis and sudden death due to respiratory insufficiency. As in this case, the cause of thoracic duct rupture can be difficult to be identified and, even at necropsy, in some cases it is not possible to identify the site of the rupture and lymph extravasation 5,8 . Chylothorax may be idiopathic, but it is often caused by trauma, such as accidents, falls, or gunshots.…”

“…Cellular components observed in the thoracic material cytology of this emperor tamarin, with abundant small lymph cells and macrophages filled with intracytoplasmic vacuoles interpreted as lipid-containing vacuoles, are similar to the description in other cases of chyle accumulation. 5,8 The most important differential diagnosis in this case would be pleuritis. However, the absence of pleural inflammation and the absence of pathogens in the thoracic fluid ruled out the possibility of pleuritis.…”

“…13 Dyspnea and death associated with respiratory insufficiency have been reported in other species due to pulmonary compression by the chyle accumulation. 5,8 In this emperor tamarin, respiratory insufficiency was the cause of death and a consequence to the lung compression by the chylothorax. This report demonstrates that, although chylothorax is a rare condition, it is important to be considered and investigated in cases of dyspnea and respiratory insufficiency in neotropical primates.…”

“…As in this case, the cause of thoracic duct rupture can be difficult to be identified and, even at necropsy, in some cases it is not possible to identify the site of the rupture and lymph extravasation. 5,8 Chylothorax may be idiopathic, but it is often caused by trauma, such as accidents, falls, or gunshots. It may also be a consequence of surgical procedures.…”