Primary chylopericardium: A case report and literature review

Yu,Xue; Jia,Na; Ye,Sanxia; Zhou,Min; Liu,Deping

doi:10.3892/etm.2017.5383

Primary chylopericardium: A case report and literature review

Authors:
- Xue Yu
- Na Jia
- Sanxia Ye
- Min Zhou
- Deping Liu
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Affiliations: Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, P.R. China, Department of Internal Medicine, Beijing Shijitan Hospital, Beijing 100038, P.R. China, Department of Cardiology, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213003, P.R. China
Published online on: October 27, 2017 https://doi.org/10.3892/etm.2017.5383
Pages: 419-425

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Abstract

Primary chylopericardium (CP) is a rare clinical condition in which chylous fluid containing high concentrations of triglyceride accumulates in the pericardial cavity. The present study reports a case of CP that was successfully treated by reconstruction surgery of thoracic duct. To improve the ability to diagnosis and treat this rare disease, the current study also systematically extracted 104 reported cases of primary or idiopathic CP from the past 60 years (January 1950 to December of 2015), and reviewed the clinical manifestation, etiology, diagnosis and treatment of these cases. The age at diagnosis varied between 6 weeks and 79 years with a mean age of 27.95±16.50 years. Asymptomatic patients accounted for 39.42% of cases, while the most common initial symptoms were dyspnea (44.23%) and coughing (10.58%). Jugular venous distention and distant heart sound was identified in 23 (22.12%) and 34 cases (32.69%), respectively. Cardiomegaly in X‑ray scans was detected in the majority of patients (93.27%). In addition, lymphoscintigraphy and lymphangiography were helpful in identifying the source of chyle. Regarding the etiology, idiopathic cases accounted for 35.56% of the included cases in the present study. The most important cause of primary CP was abnormal connection or accumulation of lymph fluid in the pericardium (37.50%). Conservative therapy included low‑fat or medium‑chain triglyceride diet, as well as total parenteral nutrition. The majority of patients (71.2%) required surgery for definitive therapy, and thoracic duct ligation was the most preferred surgical procedure, performed in 44.23% of cases. Follow‑up was reported in 64 cases, and all patients survived during the mean follow‑up period of 12 months. Therefore, it is suggested that surgical management is the most successful treatment method and is associated with a favorable prognosis.

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