Mediastinal Chyloma after Ascending Aortic Replacement: A Case of Delayed, Localized Chyle Leakage

Graft-related complications, such as pseudoaneurysms and seromas, are rare following aortic replacement. The occurrence of localized chyle leakage is exceptionally uncommon. A 59-year-old male presented with chest pain due to an expanding 5-cm perigraft fluid collection 5 years after emergent ascending aortic replacement for acute aortic dissection. Surgical intervention was indicated as a pseudoaneurysm could not be ruled out. Intraoperatively, a chronic, localized chyle leakage (chyloma) was confirmed around the graft, showing high triglyceride and total cholesterol levels on biochemical analysis. The chyloma wall was resected and cauterized. No recurrence of perigraft fluid accumulation was observed during 5 years.