Chylous Cardiac Tamponade with Chylothoraces Secondary to Hodgkin's Lymphoma: Octreotide in Conjuncture with Standard of Care Dietary Fat Restriction

Abstract

Chylous effusions are a well-known complication from a variety of etiologies including trauma, malignancies, and anatomic defects, with the most common location being in the pleural space. A pericardial chylous effusion (chylopericardium) is uncommon, and a chylopericardium with concomitant bilateral chylous pleural effusions (chylothoraces) has only been reported in less than a handful of case reports. Our patient presented with bilateral chylothoraces and a chylopericardium with tamponade physiology secondary to Hodgkin's Lymphoma. In this article, we discuss our treatment of this patient with the somatostatin analogue octreotide, as well as the standard of care dietary fat restriction, in order to control these effusions until the patient's chemotherapy took effect.

Figure 1

AP chest radiograph of the patient in the ED illustrating bilateral left greater than right chylous pleural effusions upon initial presentation.

Figure 2

A transthoracic echocardiogram illustrating an apical four-chamber view of the patient's heart during diastole illustrating right ventricular free wall collapse.

Figure 3

The patient's left chest tube with 1950cc of fluid drainage. You can clearly see the pleural fluid transitioning from pure chylous to almost completely serous.