Uptake and release of fatty acids by rat adipose tissue: last in to first out?
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A 49-year-old man with mitral regurgitation developed chylopericardium after mitral valve replacement. On postoperative day (POD) 1, the patient was started on a regular diet. On POD 2, drainage from retrosternal and intrapericardial tubes increased, becoming turbid and milky. Because the triglyceride concentration was high at 197 mg/dl, we diagnosed the condition as chylopericardium. The patient was given nothing by mouth for 2 days and, from POD 4, received a low-fat diet, after which drainage cleared and volume decreased. The 2 drainage tubes were removed on POD 6, and he was discharged without complications on POD 18.
The cause of chyluria cannot be easily detected by CT scan or other imaging methods, except conventional lymphography, but Tc-99m diethylenetriamine pentaacetic acid radionuclide lymphography clearly revealed the location of chyluria in the left renal pelvic area. Radionuclide lymphography is one of the choices in investigating chyluria due to its noninvasive and simple technique.
Primary idiopathic chylopericardium is rare and represents a fraction of all pericardial effusions in the pediatric population. Most cases of chylopericardium occur as a complication of cardiac surgery or after trauma. They may also be caused by tuberculosis, neoplasm, or congenital lymphangiomatosis. Primary idiopathic chylopericardium is a rare disease with unknown etiology. In assessing pediatric patients with an enlarged cardiac silhouette one should be aware of this entity and its presentation. We report two cases of primary idiopathic chylopericardium, one of which at 6 weeks of age is the youngest case to our knowledge so far reported.
We report the CT and MRI appearances of dilated retroperitoneal lymphatic channels in six patients. In two patients, these dilated channels resembled a mass of confluent low-density lymph nodes on CT. On MR urography the lymphatic channels in all six patients were seen as a meshwork of multiple tubular, tortuous, fluid-filled structures in the retroperitoneum of the abdomen and pelvis. On axial T1W images, these channels were seen as numerous, interconnected small, nodular and streaky intensities and as a cloak of diffuse homogenous hyperintensity on T2W axial images. The lymphatic nature of these abnormalities was confirmed at surgery in one patient. In another patient, the calibre and number of the dilated retroperitoneal channels reduced following anti-filarial therapy. The remaining four patients presented with chyluria.
A case is presented of an adult chylous cyst of the mesentery that was preoperatively diagnosed to be a pancreatic cystadenoma. A 66-year-old asymptomatic male was followed up for 15 months under the diagnosis of a benign pancreatic cyst. On October 1997, computed tomography showed a 45 x 40 mm cystic mass in the upper abdomen which came in contact with the pancreas. Endoscopic ultrasonography revealed a multilocular mass with a 7 x 4 mm elevated lesion. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed the cystic mass to be unrelated to the pancreatic duct. The preoperative diagnosis was a pancreatic cystadenoma or cystadenocarcinoma. A laparotomy showed a 50 x 40 mm cystic mass containing chylous fluid, that arose from the mesentery of the upper part of the jejunum. The pathological diagnosis was a chylous cyst of the mesentery. The preoperative diagnosis in this case was very difficult because the chylous cyst appeared to be attached to the pancreas and this phenomenon is considered to be extremely rare.
A giant chylolymphatic cyst from the jejunal mesentery in a 4-year-old boy is herein described. The child presented with an acute intestinal obstruction and the etiology of the obstruction was only discovered at surgery, even though preoperative abdominal sonography had hinted at the presence of a mesenteric lesion. An excision of the cyst, along with part of the involved bowel, was performed and was curative. The literature regarding the origin, presentation, complications, and particularly, the diagnosis of this rare lesion is also reviewed.
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A report of a case of chylous pericardium and a review of previously reported cases are given. The specific diagnosis can be made with pericardiocentesis and analysis of the fluid which is milky in appearance and contains fat droplets microscopically. Thoracic duct obstruction with failure of adequate collateral drainage and resultant reflux of chylous lymph through lymphatics draining the heart and pericardium is proposed as a mechanism of development of this entity. Thoracic duct ligation and partial pericardectomy remain the preferred treatment for chylopericardium.
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