Transabdominal ligation of the thoracic duct with pericardial-peritoneal shunting in a case of primary idiopathic chylous pericardial effusion

Rivera-Beltrán, Sandra; Ortíz, Victor N.; Díaz, Rubén Valdez; Hernández, José Antonio Bonilla

doi:10.1016/j.jpedsurg.2013.04.004

Cited by 6 publications

(6 citation statements)

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“…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). Video-assisted thoracoscopic surgery is also becoming more favorable by cardiothoracic surgeons since it is less invasive and affects the pulmonary function to a lesser extent.…”

Section: Discussionmentioning

confidence: 99%

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%

Primary chylopericardium: A case report and literature review

Xue

Jia

et al. 2017

Exp Ther Med

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“…In the paediatric population, secondary chylopericardium can be caused by systemic infection, Volume 9; Issue 01 Cardiolog Res Cardiovasc Med, an open access journal ISSN: 2575-7083 malignancy including lymphoma, and most commonly trauma or surgery [16]. Idiopathic chylopericardium can rarely be caused by thoracic lymph vessel anomalies as is seen in our case [17,18].…”

Section: Discussionmentioning

confidence: 65%

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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“…Chan et al show that the conservative approach is successful only in 55 percent of the cases [12]. However, in conditions with large recurrent chylous effusions and significant nutritional loss, a surgical approach involving ligation of the thoracic duct and tributary lymphatics or the creation of a pericardio-peritoneal shunt is advised [13,14].…”

Section: Discussionmentioning

confidence: 99%

A Rare Occurrence of Chylopericardium in a Case of Anterior Mediastinal Mass

Maheswaran Nair,

Kurian,

Thangakunam

2024

Cureus

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Transabdominal ligation of the thoracic duct with pericardial-peritoneal shunting in a case of primary idiopathic chylous pericardial effusion

Cited by 6 publications

References 20 publications

Primary chylopericardium: A case report and literature review

Primary chylopericardium: A case report and literature review

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

A Rare Occurrence of Chylopericardium in a Case of Anterior Mediastinal Mass

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