Delayed chylopericardium after coronary artery bypass grafting successfully treated with conservative therapy: a case...

Chylopericardium (CP), a rare condition characterized by the accumulation of chylous fluid in the pericardial cavity, results from lymphatic system disruption. It represents a potentially life-threatening complication following coronary artery bypass grafting (CABG), usually resulting from iatrogenic injury to the thoracic duct.

We present a case of a 57-year-old male who, 2 weeks after CABG, developed progressive dyspnea. Subsequent echocardiography revealed severe pericardial effusion. Pericardial fluid analysis demonstrated chylous fluid with elevated triglycerides and protein concentrations, consistent with a diagnosis of CP. The patient achieved complete recovery following pericardiocentesis, continuous drainage, and the initiation of a strict high-protein, low-fat diet, without the need for further surgical intervention.

CP following CABG is a rare but severe complication, typically attributed to inadvertent injury to the thoracic duct or its tributaries during surgery. While most reported cases present early in the postoperative period, this case is distinguished by a delayed onset approximately 2 weeks after surgery. The mechanism underlying this delayed presentation may involve gradual dilation of a partially injured thoracic duct or its branches during the operation, leading to chyle leakage into the pericardial cavity. Alternatively, the increase in chyle flow associated with the resumption of oral intake may contribute, rather than an immediate high-volume leak.

CP should be included in the differential diagnosis for late-onset postoperative pericardial effusion, even after an initially uneventful early postoperative course. Our case demonstrates that a structured, non-operative approach can be curative for hemodynamically stable patients with post-CABG CP, even with delayed presentation, thereby offering a management pathway that may avoid the morbidity associated with repeat thoracic surgery.