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Primary chylopericardium: report of a case
1Department of Pediatrics, Chang Gung Memorial Hospital, Taipei, Taiwan R.O.C.
Summary
A rare case of chylopericardium and chylothorax in a teen was successfully treated with thoracic duct ligation and shunting. This intervention resolved the massive effusions, preventing further accumulation.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pediatric Medicine
Background:
- Chylopericardium and chylothorax are rare conditions characterized by lymphatic fluid accumulation in the pericardial and pleural spaces, respectively.
- Exertional dyspnea in adolescents can indicate serious underlying cardiovascular or lymphatic pathology.
Observation:
- A 14-year-old female presented with exertional dyspnea, a heart murmur, and significant pericardial and pleural effusions.
- Diagnostic imaging revealed thoracic duct obstruction with leakage into the pericardial and pleural spaces, confirmed as chyle.
- Initial conservative management with dietary changes and drainage was insufficient, leading to massive reaccumulation of effusions.
Findings:
- Surgical intervention including thoracic duct ligation, pericardio-pleural window creation, and shunt placement was performed.
- The combination of surgical procedures effectively managed the lymphatic leakage and effusion reaccumulation.
- One-year follow-up demonstrated complete resolution of pericardial effusion without further accumulation.
Implications:
- This case highlights the effectiveness of surgical management for complex chylous effusions secondary to thoracic duct obstruction in adolescents.
- Aggressive surgical strategies may be necessary when conservative measures fail to control lymphatic leakage.
- Multidisciplinary collaboration between cardiology, thoracic surgery, and pediatric specialists is crucial for optimal patient outcomes.