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Chylopericardium with cardiac tamponade after cardiovascular surgery in two patients.

Two patients developed postoperative chylopericardium leading to acute cardiac tamponade. Delayed diagnosis and urgent throacotomy did not prevent death in three-month-old patient after the Glenn anastomosis of the superior vena cava to the right pulmonary artery, whereas early recognition of chylopericardium following repair of an interrupted aortic arch in an 11-week-old patient was successfully treated by tube pericardiostomy. The literature is reviewed, and an anatomic predisposition for post-surgical chylopericardium is proposed.

Acute Disease↗

Isolated massive chylopericardium. Complication of open heart surgery for aortic valve replacement.

Chylopericardium following open-heart surgery for aortic valve replacement in a 53-year-old woman is described. Five weeks after surgery, the chylous pericardial effusion was detected when the patient developed recurrent chest pain and cardiomegaly. Treatment included drainage of the fluid and partial pericardiectomy. No recurrence of the chylopericardium was observed in this patient up to 14 months after surgery.

Aortic Valve↗

Chylous reflux syndrome involving the pericardium and lung.

A ten-year-old boy with symptom-free pulmonary interstitial edema and pericardial effusion was found to have a chylous reflux syndrome involving the pericardium and lung. Evidence suggests that unlike patients with isolated primary chylopericardium in whom pericardial window and/or ligation of the thoracic duct is curative, those with chylous reflux should be managed medically since the morbidity and mortality of surgical treatment is high in this syndrome.

Child↗

Primary chylopericardium.

In a 23-year-old man with massive chylous pericardial effusion, oral administration of Sudan III and radio-active 131iodine-labelled triolein revealed an abnormal communication between the lymphatic system and the pericardial sac. Despite partial pericardiectomy and resection of the thoracic duct, the fluid reaccumulated, and a postoperative lymphangiogram showed an obstructed left thoracic duct. Resection of this left thoracic duct resulted in full recovery. This is the first reported case of this disease with a duplicate thoracic duct. Careful attention must be paid to the possibility of this variation before and during surgery.

Adult↗

CT diagnosis of chyluria after partial nephrectomy.

OBJECTIVE: The purpose of this study was to describe the CT diagnosis of chyluria after partial nephrectomy. CONCLUSION: Fat in the bladder can be identified on CT after partial nephrectomy. This finding is caused by chyluria secondary to lymphatic injury and should not be mistaken for other abnormalities. Our study population did not need treatment of chyluria.

Adult↗

Primary chylopericardium: the role of lymphangiography.

Primary chylopericardium is often a benign asymoptomatic disease, but patients with associated mediastinal lymphatic tumors may develop cardiac tamponade. Lymphangiography demonstrates mediastinal lymphatic abnormalities in these high risk patients on whom subtotal pericardiectomy and thoracic duct ligation should be performed. Since such tumors have been found in half of reported cases and because extrathoracic lymphangiomas may coexist, lymphangiography with skeletal survey is recommended in all cases. These conclusions are based on a review of 31 published cases and an additional case of our own. Lymphangiographic findings were available in 17 of these patients.

Adolescent↗

Primary idiopathic chylopericardium: report of a case and review of the literature.

Primary or isolated chylopericardium of unknown etiology is considered a rare cause of pericardial effusion. Its etiology is obscure but certain communication between the lymphatic system and pericardial sac was suggested. Up to 1991, there was only one case report that successfully showed the direct communication by a lymphangiogram. We report a case of chylopericardium occurring in a nearly asymptomatic 22-year-old man with no apparent history of trauma, infection or mediastinal neoplasm, in which we succeeded in visualizing the communication between the thoracic duct and pericardial sac by lymphangiography and computed tomography of the chest. A review of the previous cases is described also.

Adult↗

Thoracic duct cyst presenting as a left supraclavicular mass.

Thoracic duct cysts may occur either in the mediastinum or in the neck. The majority of such lesions occurring in the neck consist of chylous fistulae and are secondary to surgery on the neck. Fewer than five cases have been reported in the literature of primary thoracic duct cysts occurring in the neck (1).

Biopsy, Needle↗