Idiopathic chylopericardium. A case report from Saudi Arabia

Chylopericardium is a rare clinical condition in which chyle leaks into the pericardial space owing to lymphatic system derangement. It can be idiopathic or occur secondarily to another clinical condition. Optimal management is accomplished through surgical intervention to impede leaks and drain fluid. In this report, we discuss an initially asymptomatic patient with a pre-employment chest radiograph that revealed cardiomegaly. An echocardiogram revealed pericardial effusion. Medical workup was unable to determine secondary causes for effusion. Pericardiocentesis revealed milky-colored fluid with a high lymphocyte count, and a lymphoscintigraphy lymphangiogram revealed a leak into the pericardium and decreased flow through left iliac and left periaortic lymph nodes. Since the patient was asymptomatic, she was treated conservatively with diet changes, pericardial drainage, and a pericardial window procedure. This type of case risks being misdiagnosed as tuberculosis, especially in countries where tuberculosis is endemic. In such cases, assessing pericardial fluid for chyle is crucial.