Post-medistinoscopy chylopericardium

Abstract

Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies, infections or mediastinal neoplasm. We present a case of middle-aged male with no past medical history of note prior to developing heavy sweating, loss of weight and cough. A series of investigations were done including chest computed tomography which showed enlarged mediastinal lymph nodes leading to uncomplicated mediastinoscopy and lymph node biopsy. Six days after being discharged, he developed dyspnoea and chest pain. Echocardiography revealed massive pericardial effusion. Pericardiocentesis was done and surprisingly revealed milky white chylous fluid. The patient was then successfully managed without the need for further intervention.

Keywords: Chylopericardium; Mediastinoscopy; Pericardiocentesis.

Figure 1:

(a,b) CT scan pre-mediastinoscopy showing lymph nodes; (c) CXR pre mediastinoscop; and (d) CXR post mediastinoscopy.

Figure 2:

(a) CXR post readmission by pericardial effusion; (b) CT post readmission by pericardial effusion; (c) Echocardiography post readmission by pericardial effusion; and (d) Echocardiography post pericardial drainage.