Idiopathic chylopericardium: an unusual cause of cardiac tamponade

Abstract

Chylous pericardial effusion is an uncommon condition, and the treatment is difficult. We report a case of massive chylous pericardial effusion with tamponade in a 22-year-old man, managed successfully. Lymphoscintigraphy confirmed the communication between the lymphatic trunk and the pericardial space, which was surgically ligated. There are relatively few published reports of idiopathic chylopericardium, and its pathogenesis remains unknown. The most effective treatment is surgical ligation of the thoracic duct and creation of a pericardial window.

Fig. 1 Chest radiograph shows an enlarged cardiac silhouette.

Fig. 2 A) Chylous pericardial drain. An average of 500 to 600 mL/day was drained; this was reduced to 250 to 300 mL/day by dietary modification (B).

Fig. 3 Lymphoscintigraphy shows pericardial accumulation of technetium-99m sulfur colloid and possible site of leak from the thoracic duct.

Fig. 4 Intraoperative photo shows the chylous leak into the pericardial space (arrow).

Fig. 5 The thoracic duct (arrow), which is leaking chyle into the pericardial space at a point close to the left subclavian artery (*), is doubly ligated.