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Chylous ascites caused by constrictive pericarditis
M P Savage1, S J Munoz, W M Herman
1Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Insights
Constrictive pericarditis can cause chylous ascites, a rare condition usually linked to lymphatic obstruction. Surgical relief of pericarditis resolved the ascites, highlighting this curable cause.
Area of Science:
- Cardiology
- Gastroenterology
- Thoracic Surgery
Background:
- Chylous ascites is typically caused by lymphatic obstruction, often due to malignancy.
- Understanding alternative etiologies is crucial for effective management.
Observation:
- A case of chylous ascites was observed in a patient without mechanical lymphatic obstruction.
- The patient's condition was attributed to constrictive pericarditis.
Findings:
- Constrictive pericarditis can lead to chylous ascites through increased lymph production and impaired drainage due to central venous hypertension.
- Pericardiectomy successfully treated the patient's chylous ascites and edema.
Implications:
- Constrictive pericarditis is a rare, yet treatable, cause of chylous ascites.
- Consideration of constrictive pericarditis in unexplained chylous ascites cases is warranted.
- Surgical intervention can offer a curative solution for this condition.
Abstract:
Chylous ascites is an uncommon clinical entity associated with lymphatic obstruction usually caused by underlying malignancy. The authors describe a patient with chylous ascites caused by constrictive pericarditis in the absence of mechanical lymphatic obstruction. Pathophysiological mechanisms for the development of chylous ascites in constrictive pericarditis include augmented lymph production and high impedance to lymph drainage caused by central venous hypertension. After pericardiectomy, the patient's ascites and edema resolved. Constrictive pericarditis should be considered a rare but potentially curable cause of chylous ascites.