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[Minimally invasive treatment for traumatic chylopericardium. Paediatric case report]
Carlos García-Hernández1, Lourdes Carvajal-Figueroa1, Adriana Calderón-Urrieta1
1Hospital Infantil Privado, México, D. F., México.
Insights
Traumatic chylopericardium in a child, though rare, was successfully treated with minimally invasive surgery after medical treatments failed. This case highlights surgery as a viable option for persistent pericardial effusion.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Chylopericardium is a rare condition in children, often linked to cardiac surgery or lymphatic malformations.
- Idiopathic cases and traumatic etiologies are less common but significant.
- Prompt diagnosis and management are crucial for pediatric patients.
Observation:
- A 6-year-old male presented with cardiomegaly and pericardial effusion following a fall.
- Diagnostic imaging confirmed pericardial effusion, and pericardiocentesis revealed chylous fluid.
- Initial medical management (catheterization, nutrition, octreotide, diet) proved insufficient.
Findings:
- Despite conservative measures, pericardial fluid persisted, necessitating surgical intervention.
- A thoracoscopic approach was employed for surgical treatment.
- The minimally invasive surgery resulted in a favorable outcome for the patient.
Implications:
- This case underscores the importance of considering traumatic causes of chylopericardium in children.
- Minimally invasive surgery offers an effective alternative when medical management fails.
- Early surgical consideration may improve outcomes in complex pediatric chylopericardium cases.
Background:
Chylopericardium is a rare occurrence in children. The most common causes are associated with cardiac surgery, malformations of the lymphatic system, idiopathic reasons, among others.
Objective:
The case is presented of a patient with traumatic chylopericardium, the diagnostic methodology, and in particular, its successful resolution by surgical means.
Clinical Case:
Male patient of 6 years old, previous accident of fall from patient's height. Chest x-ray showed evidence of cardiomegaly. An echocardiogram with pericardial effusion was performed. Pericardial puncture was performed with drainage of milky material, confirming chylous liquid. Treatment included pericardial catheterisation, total parenteral nutrition, octreotide, and diet with medium chain triglycerides, with persistent increased pericardial fluid. Lymphatic abnormalities were ruled out by MRI. He underwent surgical treatment due to failure of prior treatment. A thoracoscopic approach was adopted with a favourable outcome.
Conclusions:
Chylopericardium occurs in children in most cases after cardiovascular surgery. The case presented here was classified as idiopathic. Patients with this condition may present with severe symptoms, such as tamponade, or can be asymptomatic as in the case presented. If medical treatment fails, it should be resolved by surgery; the best choice is minimally invasive treatment with its well-known advantages.
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