Chylous pericardial effusion after pulmonary lobectomy

Abstract

Chylous pericardial effusion is a rarely reported complication of lung cancer surgery. Here, we report a case of an elderly man who suffered chylous pericardial effusion after radical right upper lung resection for cancer. The massive chylous effusion first occurred in the pericardium, drained to the right chest after the drainage of the hydropericardium and subsequently moved back to the pericardium again. Lymphoscintigraphy examination indicated that a chylous fistula was present in the plane of the tracheal carina. After failure to control the chylous effusion with conservative medical treatment, the patient underwent video-assisted thoracic surgery through the left chest for thoracic duct ligation and pericardial fenestration. The patient was ultimately discharged without recurrence of the effusion after surgical treatment. This case report discusses the possible mechanism of chylopericardium after lung cancer surgery and suggests some strategies to prevent postoperative chylous pericardial effusion.

Pericardial Tamponade in a Patient With a History of Pneumonectomy

“…They also noted that patients who underwent left pneumonectomy returned within 30 days postoperatively with pericardial effusions requiring drainage, while patients who had undergone right pneumonectomy thoracotomies generally did well with diuretic medications alone and required no further surgical intervention [ 7 ]. Case reports describe development of pericardial effusions secondary to development of chylous fistulas in patients who underwent right upper lung lobectomy [ 8 ]. Development of a pericardial effusion has been more frequently described as a complication of cardiac surgery such as heart transplant, though the reported incidence varies widely between 1% and 77%.…”