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Suppression of fluid accumulation following pericardial inflammation in a patient with primary chylopericardium
M Chinushi1, Y Watanabe, Y Aizawa
1First Department of Internal Medicine, Niigata University, Japan.
Insights
A rare case of primary chylopericardium resolved unexpectedly after catheter removal due to inflammation. This inflammatory process may have led to adhesions, preventing further chylopericardium fluid accumulation.
Area of Science:
- Cardiology
- Internal Medicine
- Surgical Gastroenterology
Background:
- Primary chylopericardium is a rare condition characterized by the accumulation of chylous fluid in the pericardial sac.
- Management often involves dietary modifications and surgical intervention to address the underlying cause of lymphatic fluid leakage.
Observation:
- A 50-year-old woman with primary chylopericardium presented with continuous triglyceride-rich fluid drainage via an indwelling catheter.
- A medium-chain triglyceride diet proved insufficient in controlling fluid accumulation, necessitating surgical planning.
Findings:
- Prior to surgery, localized inflammation around the indwelling catheter prompted its immediate removal.
- Antibiotic treatment resolved the inflammation, and importantly, the pericardial effusion ceased to accumulate over a 10-month follow-up period.
- The resolution is hypothesized to be due to inflammation-induced fibrin production and adhesions within the pericardial cavity, potentially occluding the abnormal connection.
Implications:
- This case suggests that inflammatory processes, even those requiring catheter removal, can unexpectedly resolve chylopericardium.
- It highlights a potential non-surgical mechanism for managing pericardial effusion in specific cases.
- Further investigation into inflammation-induced adhesions as a therapeutic pathway for chylopericardium may be warranted.
Abstract:
The patient was a 50-year-old woman with primary chylopericardium. Triglyceride rich chyloid fluid was continuously drained from the pericardial space through an indwelling catheter. A surgical procedure was scheduled since a medium chain triglyceride diet was insufficient to control the fluid accumulation. Before the operation, inflammatory signs were apparent around the indwelling catheter and the catheter was removed immediately. The inflammation was easily treated with antibiotics, and the pericardial effusion no longer accumulated during a follow-up period of 10 months. The inflammatory process may have caused fibrin production and tissue adhesion in the pericardial cavity, and these might have prevented an accumulation of chyloid fluid and occluded the connection between the thoracic duct and the pericardial cavity.