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[Spontaneous idiopathic chylopericardium in childhood]

D Attias1, P Ou, P Souillard

  • 1Cardiologie pédiatrique, Université Paris V, Necker-Enfants malades, Paris.

Archives Des Maladies Du Coeur Et Des Vaisseaux
|June 29, 2006
PubMed

Insights

A rare case of primary idiopathic chylopericardium in a child was successfully treated. Thoracic duct ligation and pericardectomy resolved the pericardial effusion, preventing recurrence.

Area of Science:

  • Cardiology
  • Pediatric Surgery
  • Thoracic Surgery

Background:

  • Primary idiopathic chylopericardium is a rare condition characterized by the accumulation of chylous fluid in the pericardial space.
  • Diagnosis in pediatric patients often involves identifying chest pain and fatigue as key symptoms.

Observation:

  • A 13-year-old child presented with symptoms suggestive of pericardial effusion.
  • Initial management included pericardiocentesis, draining 800mL of chylous fluid, but the cause remained elusive despite extensive investigations.
  • Recurrent effusions occurred despite a medium-chain triglyceride diet.

Findings:

  • Advanced imaging, including CT scans, lymphoscintigraphy, and MRI, failed to reveal a direct connection between the thoracic duct and the pericardium.
  • Surgical intervention involving thoracic duct ligation and partial pericardectomy was performed due to recurrent effusions.
  • The surgical approach resulted in complete resolution of the chylopericardium.

Implications:

  • This case highlights thoracic duct ligation and partial pericardectomy as an effective treatment for refractory primary idiopathic chylopericardium in children.
  • The findings suggest that surgical management can be considered when conservative measures fail.
  • Successful long-term resolution without recurrence underscores the viability of this surgical strategy.

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