Idiopathic chylopericardium. A case report from Saudi Arabia

Abstract

Chylopericardium is a rare clinical condition in which chyle leaks into the pericardial space owing to lymphatic system derangement. It can be idiopathic or occur secondarily to another clinical condition. Optimal management is accomplished through surgical intervention to impede leaks and drain fluid. In this report, we discuss an initially asymptomatic patient with a pre-employment chest radiograph that revealed cardiomegaly. An echocardiogram revealed pericardial effusion. Medical workup was unable to determine secondary causes for effusion. Pericardiocentesis revealed milky-colored fluid with a high lymphocyte count, and a lymphoscintigraphy lymphangiogram revealed a leak into the pericardium and decreased flow through left iliac and left periaortic lymph nodes. Since the patient was asymptomatic, she was treated conservatively with diet changes, pericardial drainage, and a pericardial window procedure. This type of case risks being misdiagnosed as tuberculosis, especially in countries where tuberculosis is endemic. In such cases, assessing pericardial fluid for chyle is crucial.

Figure 1

Timeline of the studied participant.

Figure 2

Echocardiogram of the patient at presentation. A) Subcostal 4 chamber view with white arrow representing large circumferential pericardial effusion. B) M-Mode echocardiogram with white arrow represents early diastolic right ventricular collapse, and the red arrow represents large posterior pericardial effusion.

Figure 3

A chest radiograph revealing an enlarged cardiac silhouette, a pericardial drain is noted in place. The lungs appear unremarkable apart from left basal atelectasis.

Figure 4

NM-lymphatic-lymphangiogram scintigram showing abnormal trace accumulation of chyle in the pericardial space, a representative feature of chylopericardium.