Primary chylopericardium: a review of the literature and an illustrated case

Dunn, Robert P.

doi:10.1016/0002-8703(75)90088-5

Cited by 54 publications

(24 citation statements)

References 26 publications

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“…Lymphatic vessels of the heart drain the pericardial fluid into the left subclavian vein via the mediastinal lymph vessels, lymph nodes and the thoracic duct (10). The main lymphatic flow from the pleura, the lower portion of the left lung, and the entire right lung and pericardium meet at the bronchomediastinal lymphatics (11,12). Therefore, lymphatic flow regurgitation can occur simultaneously in multiple sites in the thoracic cavity, such as the pleura, lungs and pericardium.…”

Section: Discussionmentioning

confidence: 99%

“…Causes of CP include congenital mediastinal lymphangiectasia, iatrogenic development following cardiac surgery, malignant tumors, blunt or penetrating trauma, infection and congenital lymphatic anomalies (6,11,(13)(14)(15). It has been reported that ~56% of cases are idiopathic (6), and only ~100 CP cases have been reported worldwide (16).…”

Section: Discussionmentioning

confidence: 99%

“…Pericardiectomy is performed to ensure complete drainage and to prevent secondary constrictive pericarditis. Creation of a pericardial window alone is insufficient since it has a high recurrence rate, as it does not close the communication between the thoracic duct and the pericardial sac (11). Ligation of the thoracic duct above the level of the diaphragm is the best choice and is recommended by the majority of surgeons (81).…”

Section: Discussionmentioning

confidence: 99%

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Primary chylopericardium: A case report and literature review

Xue

Jia

et al. 2017

Exp Ther Med

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Abstract. Primary chylopericardium (CP) is a rare clinical condition in which chylous fluid containing high concentrations of triglyceride accumulates in the pericardial cavity. The present study reports a case of CP that was successfully treated by reconstruction surgery of thoracic duct. To improve the ability to diagnosis and treat this rare disease, the current study also systematically extracted 104 reported cases of primary or idiopathic CP from the past 60 years (January 1950 to December of 2015), and reviewed the clinical manifestation, etiology, diagnosis and treatment of these cases. The age at diagnosis varied between 6 weeks and 79 years with a mean age of 27.95±16.50 years. Asymptomatic patients accounted for 39.42% of cases, while the most common initial symptoms were dyspnea (44.23%) and coughing (10.58%). Jugular venous distention and distant heart sound was identified in 23 (22.12%) and 34 cases (32.69%), respectively. Cardiomegaly in X-ray scans was detected in the majority of patients (93.27%). In addition, lymphoscintigraphy and lymphangiography were helpful in identifying the source of chyle. Regarding the etiology, idiopathic cases accounted for 35.56% of the included cases in the present study. The most important cause of primary CP was abnormal connection or accumulation of lymph fluid in the pericardium (37.50%). Conservative therapy included low-fat or medium-chain triglyceride diet, as well as total parenteral nutrition. The majority of patients (71.2%) required surgery for definitive therapy, and thoracic duct ligation was the most preferred surgical procedure, performed in 44.23% of cases. Follow-up was reported in 64 cases, and all patients survived during the mean follow-up period of 12 months. Therefore, it is suggested that surgical management is the most successful treatment method and is associated with a favorable prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Primary chylopericardium: A case report and literature review

Xue

Jia

et al. 2017

Exp Ther Med

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“…Soon the pleura ruptures and the chylus collects in the pleural space. There are some rare variations, for instance chylomediastinum, where the chylus collects in the mediastinum without breaking through the pleura [8], or chylopericardium, where it empties into the pericardial sac [9][10][11].…”

Section: Anatomy and Physiologymentioning

confidence: 99%

Chylothorax and pseudochylothorax

Hillerdal¹

1997

Eur Respir J

198

146

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Chylothorax is the occurrence of chylus (lymph) in the pleura due to damage to the thoracic duct. There is a high content of triglycerides, and chylomicrons can be seen. It is usually right-sided, since most of the duct is within the right hemithorax. With damage at the level of the aorta, the chyle will appear on the left.Traumatic rupture occurs after accidents or surgery. Of nontraumatic causes, the most common is a malignant lymphoma. Computed tomography (CT) scan of the thorax and upper abdomen should be performed. Lymphography can show where the leakage or blockage is situated. With repeated drains, large amounts of fat, proteins, and lymphocytes are lost. Treatment is with low-fat diet or parenteral nutrition to decrease the amount of chyle, but chemical pleurodesis or ligation of the thoracic duct, usually via thoracoscopy, is often necessary.Pseudochylothorax (cholesterol pleurisy) occurs with long-standing fluid in a fibrotic pleura. The fluid has a high content of cholesterol but no triglycerides or chylomicrons. In both conditions, the pleural fluid is thick, opalescent, whitish or the colour of café-au-lait.

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“…A fatty meal provides the maximal stimulation for chyle production. Pathophysiolosy of chylopericardium was firstly proposed by Dunn [6]. The thoracic duct obstruction and abnormal reflux of chyle with elevated pressure in the thoracic duct cause accumulation of chylous fluid in the pericardium.…”

Section: Discussionmentioning

confidence: 99%

Primary chylopericardium treated by surgery: Report of two cases

Hattori

Dakeshita

Nakazato

et al. 2011

Journal of Cardiology Cases

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Primary chylopericardium is a rare condition. The etiology and the treatment remain unclear. We report two cases of primary chylopericardium successfully treated by surgery. Both cases were asymptomatic young women and were found to have cardiomegaly on chest X-ray at a routine annual health examination. An echocardiography demonstrated massive pericardial effusion and chylous fluid was obtained with pericardiocentesis. Lymphoscintigraphy demonstrated abnormal communication between the pericardial sac and the thoracic duct. Because of reaccumulation of chylous pericardial effusion after conservative treatment, we performed surgical ligation of thoracic duct and partial pericardectomy by video-assisted thoracic surgery (VATS) in one case and by thoracotomy in another case. After surgery, both patients are doing well without recurrence of pericardial effusion. Surgical treatment including VATS is effective and should be performed in case of primary chylopericardium.

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Primary chylopericardium: a review of the literature and an illustrated case

Cited by 54 publications

References 26 publications

Primary chylopericardium: A case report and literature review

Primary chylopericardium: A case report and literature review

Chylothorax and pseudochylothorax

Primary chylopericardium treated by surgery: Report of two cases

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