Primary chylopericardium treated by surgery: Report of two cases

Abstract

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.

Idiopathic Chylopericardium: A case Report and Breif Review of Literature

“…CP occurs in all ages more dominantly in children and young adults [1]. The mean age in C. Dib study was about 36.78 ± 14.71 years with no gender specificity [1,2] and 27.95 ± 16.50 years in Yu et al study with 5 cases younger than 3 years [6]. The disease can be diagnosed in asymptomatic patients referred for annual health examination showing a cardiomegaly or detected by dyspnea, chest pain or cough [1].…”

“…The latest one in Beijing, China which analyzed 65 years of 92 English and Chinese studies reported 104 patients with CP in the literature [6]. CP occurs in all ages more dominantly in children and young adults [1]. The mean age in C. Dib study was about 36.78 ± 14.71 years with no gender specificity [1,2] and 27.95 ± 16.50 years in Yu et al study with 5 cases younger than 3 years [6].…”

“…Most common etiologies are congenital mediastinal lymphangiectasia, iatrogenic after cardiac surgery, malignant tumors especially mediastinal ones, Gorham syndrome (defined by osteolysis resulting from lymphangiomatosis with adjacent bone resorption), blunt or penetrating trauma, infection or radiation or congenital lymphatic anomalies. Primary or idiopathic CP is known as a less common cause [1,7,8]. Idiopathic CP is an exclusion diagnosis when no etiology is found.…”

“…Chylopericardium (CP) is accumulation of chylous fluid in the pericardial cavity [1]. It is considered idiopathic or primary when no etiology is found after investigations.…”

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

“…Conservative treatment is not to exceed 14 days, and treatment failure is seen in up to 61% [34] of cases. There are no indicators that predict conservative treatment failure.…”