Spontaneous chylous cardiac tamponade: a case report

Barbetakis, Nikolaos; Asteriou, Christos; Konstantinou, Dimitrios; Giannoglou, Dimitrios; Tsilikas, Christodoulos; Giannoglou, Georgios

doi:10.1186/1749-8090-5-11

Cited by 10 publications

(11 citation statements)

References 9 publications

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“…It may be a consequence of thoracic and cardiac surgery or as a result of chest trauma, mediastinal tuberculosis, mediastinal neoplasm, mediastinal radiotherapy or thrombosis of subclavian vein. The term primary isolated chylopericardium was first reported by Groves and Effler in 1954 1 . Abnormalities of the lymphatic system and mediastinal lymphangiectasia causing chylopericardial effusions are referred to as idiopathic chylopericardium.…”

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confidence: 99%

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Cystic lymphangioma of pericardium presenting as isolated chylopericardium – A case report

Vinayakumar

Arunkumar

Sajeev

et al. 2014

Indian Heart Journal

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Isolated chylopericardium due to cystic lymphangioma of pericardium is a rare entity. We report a case of asymptomatic chylopericardium in a young male who presented with cardiomegaly. Echocardiography revealed massive pericardial effusion without tamponade. Pericardiocentesis yielded 1.25 L of tea-colored fluid which showed triglyceride level of 1723 mg/dL and cholesterol of 1021 mg/dL with a cholesterol to triglyceride ratio of <1, characteristic of chylous fluid. Lymphoscintigraphy using 99Tc demonstrated lymphatic leak around the heart region. Fusion of MRI images with lymphoscintigraphy was taken with a view of localizing the leak site; it demonstrated enhancement in the pericardial space. Surgery was done via right lateral thoracotomy. Thoracic duct was ligated above diaphragm and pericardial window created by anterior pericardiectomy. The patient had an uneventful recovery and was well after 6 months of follow up. Pericardial biopsy showed cystic lymphangioma of pericardium.

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“…The term primary isolated chylopericardium was first reported by Groves and Effler in 1954. 1 Abnormalities of the lymphatic system and mediastinal lymphangiectasia causing chylopericardial effusions are referred to as idiopathic chylopericardium. Age at diagnosis ranges from 18 to 68 years.…”

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confidence: 99%

Cystic lymphangioma of pericardium presenting as isolated chylopericardium – A case report

Vinayakumar

Arunkumar

Sajeev

et al. 2014

Indian Heart Journal

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“…Chylopericardium is an entity defined as the accumulation of chylous fluid in the pericardial space. It is typically the result of chest trauma [7], thoracic surgical procedures [8], mediastinal radiotherapy, mediastinal neoplasms [7,8], signet-ring cell carcinoma of the stomach [10], mediastinal tuberculosis, filariasis, thrombosis of the subclavian vein [7] and vena cava [11], Behcet's syndrome [12], congenital lymphangiomatosis, Gorham-Stout disease (osteolysis secondary to lymphangiomatosis with bone resorption) [13], congenital mediastinal lymphangiectasia and congenital lymphatic anomalies [12]. A recent case report describes a unique case of chylothorax and chylopericardium in end stage renal disease patient on hemodialysis with a left jugular tunneled catheter who developed superior vena cava syndrome [3], thus increasing the etiology of this illness.…”

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confidence: 99%

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Aranalde¹,

Lorenzin²,

Cánaves³

et al. 2019

AJIM

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The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.

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“…Furrer and Nikolaos performed duct ligation and pericardial window formation by means of right-sided thoracoscopy [ 19 , 20 ]. The identification and ligation of the thoracic duct from a low position are no different from the methods used in traditional surgery.…”

Section: Discussionmentioning

confidence: 99%

Primary idiopathic chylopericardium: a retrospective case series

Han

Jing

et al. 2015

BMC Surg

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BackgroundPrimary idiopathic chylopericardium is a rare clinical entity characterized by the accumulation of chyle within the pericardial cavity without a definitive cause. The aim of this study was to assess the clinical presentation, etiology, diagnosis, treatment and follow-up of primary idiopathic chylopericardium.MethodsWe retrospectively reviewed 9 cases of patients who suffered from primary idiopathic chylopericardium at our hospital from January 1993 to November 2013.ResultsThere were two males and seven females among our patients. Their ages ranged from 13 to 55 years. The most common clinical presentation was dyspnea. The etiology was idiopathic. All patients were diagnosed by pericardiocentesis, computed tomography of the chest and lymphoscintigraphy. Non-surgical therapy was adopted in all nine patients and failed in six, who underwent subsequent successful surgery. Thoracic duct ligation with the creation of a pericardial window was the most common surgical procedure. All patients were followed up from 3 months to 9 years, and no recurrence occurred.ConclusionsIn assessing patients with an enlarged cardiac silhouette, one should be aware of primary idiopathic chylopericardium. The most effective treatment is ligation of the thoracic duct and the creation of a pericardial window.

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Spontaneous chylous cardiac tamponade: a case report

Cited by 10 publications

References 9 publications

Cystic lymphangioma of pericardium presenting as isolated chylopericardium – A case report

Cystic lymphangioma of pericardium presenting as isolated chylopericardium – A case report

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Primary idiopathic chylopericardium: a retrospective case series

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