Chylopericardium due to Subclavian Vein Thrombosis in the Setting of Protein S Deficiency

Abstract

Background. Chylopericardium is the accumulation of lymphatic fluid in the pericardial cavity. It can be idiopathic or secondary to trauma, cardiothoracic surgery, neoplasm, radiation, tuberculosis, lymphatic duct dysfunction, thrombosis, or other causes. We present a case of chylopericardium due to subclavian vein thrombosis in a patient with protein S deficiency. Clinical Case. A 48-year-old man with a history of protein S deficiency presented to the emergency department with shortness of breath and a productive cough. CT of the chest showed pulmonary emboli, moderate pericardial effusion, and a large thrombus of the superior vena cava, brachiocephalic vein, and subclavian veins. He developed echocardiographic evidence of cardiac tamponade so he underwent pericardiocentesis with drainage of milky-appearing fluid. Analysis of the fluid showed elevated triglycerides consistent with chylopericardium. The pericardial effusion reaccumulated, likely secondary to lymphatic duct obstruction due to his subclavian vein thrombus. Catheter-assisted thrombolysis was performed with resolution of the patient’s effusion and symptoms. Conclusion. Chylopericardium is a rare but important complication of subclavian vein thrombosis. Management is typically with surgical intervention, although our case represents successful treatment with catheter-assisted thrombolysis.

Case report: Chylopericardium secondary to dialysis catheter related jugular venous thrombosis in two dogs receiving long-term hemodialysis

“…This is the first known report to document the development of chylopericardium in dogs undergoing chronic hemodialysis, suspected to be associated with long-term indwelling dialysis catheters and secondary catheter-associated thrombosis and/or stenosis. The development of chylopericardium secondary to thrombosis of the superior vena cava, jugular vein or subclavian vein is well documented in human patients ( 5 , 6 , 10 , 11 ). Vena cava thrombosis and stenosis with subsequent chylopericardium have been reported in human patients with jugular catheters undergoing hemodialysis ( 12 ) and in human patients with central venous catheters in place ( 5 , 13 ).…”

“…Chylopericardium is a rare medical condition characterized by accumulation of chylous fluid within the pericardial cavity ( 1 , 2 ). Causes in humans include cardiothoracic trauma, mediastinal neoplasia, radiation therapy, jugular or subclavian vein thrombosis/stenosis, congenital lymphatic malformations, tuberculosis and other causes of elevated central venous pressure ( 1 – 6 ). No obvious cause is identified in ~50% of humans with chylopericardium ( 1 , 2 ).…”