Cardiac Tamponade from Chylopericardium Following Lobectomy and Mediastinal Lymph Node Dissection for Lung Cancer: A...

Chylopericardium is a rare but serious complication after thoracic surgery, caused by injury to thoracic duct tributaries during procedures like lymph node dissection. It leads to chylous fluid in the pericardial cavity. Prompt diagnosis is vital to prevent cardiac tamponade, malnutrition, and immunosuppression due to disrupted lymphatic drainage.

A 74-year-old man presented with neck discomfort, and a CT scan incidentally revealed a part-solid ground-glass nodule (GGN) in the right upper lung lobe, raising suspicion of primary lung cancer. Thoracoscopic lobectomy was performed, followed by mediastinal dissection, during which a small pericardial perforation occurred. On POD 4, the patient developed sudden obstructive shock secondary to cardiac tamponade. After consultation with the cardiology, cardiac surgery, and radiology departments, aortic dissection was initially suspected as the most likely cause. As a result of exploratory thoracotomy via cardiac surgery, no aortic dissection was found. Chylous fluid was found in the pericardial space and was thought to be the cause of cardiac tamponade. Conservative management of the chylous effusion was unsuccessful, and thoracoscopic ligation of the lymphatic vessels was required. No reaccumulation of the chylous pericardial fluid was observed after the intervention.

Following lung surgery, particularly when lymph node dissection or unintentional pericardial breach is performed, chylous pericardial effusion accompanied by cardiac tamponade may occur. Therefore, this complication should be considered.