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Chylopericardium or contamination by injectable lipid emulsion?
Bertrand Lefrère1, Randa Bittar1, Antoine Levasseur1
1Service de biochimie métabolique, AP-HP, Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, DMU BioGeM, Paris, France
Annales De Biologie Clinique
|December 1, 2022
Summary
A pediatric patient with short-bowel syndrome developed a pericardial effusion. This case highlights challenges in diagnosing chylopericardium versus parenteral nutrition-related effusions, especially with lipid emulsions.
Area of Science:
- Cardiology
- Pediatric Gastroenterology
- Clinical Chemistry
Context:
- A 14-month-old male with short-bowel syndrome received chronic parenteral nutrition via a Broviac® catheter.
- The patient experienced thrombosis and required catheter repositioning, leading to an intra-atrial catheter placement.
- A milky pericardial effusion developed, initially suggestive of chylopericardium.
Purpose:
- To document a rare case of pseudochyloperitoneum in a pediatric patient on parenteral nutrition.
- To investigate the diagnostic challenges in differentiating chylopericardium from parenteral nutrition-related effusions.
- To explore the interference of lipid emulsions with diagnostic tests like gel lipoprotein electrophoresis.
Summary:
- A pericardial effusion in a pediatric patient on parenteral nutrition was initially suspected to be chylopericardium based on milky fluid and gel electrophoresis.
- Biochemical analysis suggested a parenteral nutrition-related effusion, possibly pseudochyloperitoneum due to catheter migration.
- The effusion resolved after dietary modification, effusion drainage, and catheter repositioning.
Impact:
- Highlights the importance of considering catheter complications and parenteral nutrition in pediatric pericardial effusions.
- Underscores the need for careful interpretation of diagnostic tests when artificial lipid emulsions are used.
- Provides insights into managing complex cases of short-bowel syndrome requiring long-term parenteral nutrition in children.
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