Chyloptysis with chylopericardium, a rare case and mini-review

Luo, Xuming; Zhang, Zhuhua; Wang, Shi Qiang; Gu, Xiandong; Wang, Xiongbiao

doi:10.1186/s12890-018-0583-y

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Except for the chylous discharge, congenital chylorrhea (eg, GLA) can occur anywhere in the body and may be manifested as scrotal chylorrhea, 9,10 lymphedema of external genitalia, 11 chylothorax, 12,13 chylous ascites, 14,15 or chylopericardium. 16 T2-weighted MRI showed diffuse intestinal lesions (Fig 2), and the blood tests found hypoproteinemia, which indicated intestinal lymphangiectasia and protein-losing enteropathy in this patient. Hypoproteinemia may be caused by protein loss from the intestine as well as by chylous vaginal discharge in this patient ( Fig 6).…”

Section: Discussionmentioning

confidence: 73%

Vaginal discharge caused by lymphatic malformation identified by lymphoscintigraphy combined with T2-weighted magnetic resonance imaging

Tang

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Prepubertal vaginal discharge is most commonly caused by vulvovaginitis and is rarely caused by lymphatic malformations, resulting in chylous vaginal discharge. The diagnosis of chylous vaginal discharge remains a challenge because of a knowledge gap. We describe a 12-year-old girl with intermittent vaginal discharge for 10 years. Although we found a high signal in the vagina on T2-weighted magnetic resonance imaging (MRI), the final diagnosis, vaginal lymphatic leakage, was established on lymphoscintigraphy. Lymphatic leakage in the vagina on lymphoscintigraphy was the key imaging feature of chylous vaginal discharge in this patient. Moreover, diffuse radioactivity was found in the abdomen and thorax on lymphoscintigraphy, which indicated the multiple cystic lymphatic malformations and intestinal lymphangiectasia combined with T2-weighted MRI. Thus, T2-weighted MRI could be used in combination with lymphoscintigraphy to simply identify chylous vaginal discharge. (J Vasc Surg Cases and Innovative Techniques 2020;6:1-5.)

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Section: Discussionmentioning

confidence: 73%

Vaginal discharge caused by lymphatic malformation identified by lymphoscintigraphy combined with T2-weighted magnetic resonance imaging

Tang

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…Suggestive features of constrictive pericarditis on CMR include septal bounce, sudden termination of diastolic filling or respirophasic discrepancy in septal excursion 9. Lymphangiography is used most frequently for anatomical assessment of lymphatic leakage and can greatly guide surgical management of CPE 10…”

Section: Discussionmentioning

confidence: 99%

“… 9 Lymphangiography is used most frequently for anatomical assessment of lymphatic leakage and can greatly guide surgical management of CPE. 10 …”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics, evaluation and outcomes of chylopericardium: a systematic review

Verma

Kumar

Verma

et al. 2023

Heart

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ObjectiveChylopericardium (CPE) is a rare condition associated with accumulation of triglyceride-rich chylous fluid in the pericardial cavity. Due to minimal information on CPE within the literature, we conducted a systematic review of all published CPE cases to understand its clinical characteristics, management and outcomes.MethodsWe performed a literature search and identified cases of patients with CPE from 1946 until May 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant articles for pooled analyses of clinical, diagnostic and outcome data.ResultsA total of 95 articles with 98 patients were identified. Patient demographics demonstrated male predominance (55%), with a mean age of 37±15 years. Time from symptom onset to diagnosis was 5 (Q1 4.5, Q3 14) days, with 74% of patients symptomatic on presentation. Idiopathic CPE (60%) was the most common aetiology. Cardiac tamponade secondary to CPE was seen in 38% of cases. Pericardial fluid analysis was required in 94% of cases. Lymphangiography identified the leakage site in 59% of patients. Medical therapy (total parenteral nutrition, medium-chain triglycerides or octreotide) was undertaken in 63% of cases. In our cohort, 32% progressed towards surgical intervention. During a median follow-up of 180 (Q1 180, Q3 377) days, CPE recurred in 16% of cases. Of the patients with recurrence, 10% were rehospitalised.ConclusionCPE tends to develop in younger patients and may cause serious complications. Many patients fail medical therapy, thereby requiring surgical intervention. Although overall mortality is low, associated morbidities warrant close follow-up and possible reintervention and hospitalisations.

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“…Chylopericardium is rare, accounting for less than 3% of all pericardial effusions. Identifying chyle involves fluid analysis revealing a triglyceride level greater than 500 mg/ dL and a cholesterol: triglyceride ratio less than one [1]. The appearance of chyle varies, often resembling a milky white liquid, but it can occasionally exhibit hues of gold or brown [2].…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Chylopericardium in a 7-Year-Old Female with Latent Tuberculosis: A Case Report and Literature Review

2024

Cardiol Res Cardiovasc Med

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Diagnosing idiopathic (primary) chylopericardium is an extensive process that involves ruling out all potential secondary causes. Pericardiocentesis and fluid analysis are essential for diagnosis and additionally offer symptomatic relief. Management of idiopathic chylopericardium necessitates pinpointing and surgically correcting the lymphatic anomaly contributing to fluid accumulation. This case describes the diagnosis and management of idiopathic chylopericardium in a previously healthy 7-yearold female. Initial diagnosis was made with chest x-ray (CXR), transthoracic echocardiogram (TTE), and computed tomography (CT), followed by pericardiocentesis and pericardial drain placement. Pericardial fluid analysis revealed high triglycerides. Additional laboratory workup was largely unremarkable except for a positive QuantiFERON-TB Gold test. While disseminated tuberculosis infection can cause pericarditis and pericardial effusion, latent infection is unlikely to result in chylopericardium. Diagnosis of abnormal lymphatic perfusion and leakage into the pericardial sac was eventually established with dynamic contrastenhanced magnetic resonance lymphangiogram (DCMRL). Non-target embolization with lip iodol administered via bilateral inguinal lymph nodes was initially performed, but chylopericardium recurred. The patient subsequently underwent selective lymphatic embolization targeting an abnormally dilated lymphatic channel in the upper mediastinum. Repeat lymphangiogram immediately after selective embolization showed continued abnormal mediastinal lymphatic perfusion through diminutive lymphatic channels, which ultimately necessitated thoracic duct embolization. The patient had diminished pericardial effusion at three weeks post-embolization. She has been monitored with serial echocardiograms, with the most recent showing only a tiny/small amount of pericardial effusion. Continuous surveillance in the coming months and years will be essential to confirm successful embolization.

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Chyloptysis with chylopericardium, a rare case and mini-review

Cited by 5 publications

References 20 publications

Vaginal discharge caused by lymphatic malformation identified by lymphoscintigraphy combined with T2-weighted magnetic resonance imaging

Vaginal discharge caused by lymphatic malformation identified by lymphoscintigraphy combined with T2-weighted magnetic resonance imaging

Clinical characteristics, evaluation and outcomes of chylopericardium: a systematic review

Idiopathic Chylopericardium in a 7-Year-Old Female with Latent Tuberculosis: A Case Report and Literature Review

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