Chylopericardium complicating pericardiocentesis for acute idiopathic pericardial effusion.
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A rare case is presented of congenital chyluria in a 16-year-old boy. On the basis of literature data the pathological mechanism of that disease is discussed. The clinical data and examinations carried out, particularly lymphography, confirmed the preliminary clinical diagnosis.
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Postoperative lymphatic complications of mastectomy and immediate reconstruction are well documented, consisting predominantly of lymphorrhea, lymphocele, and chronic lymphoedema. Chylous fistula is a hitherto undescribed entity complicating breast surgery. It was managed successfully by cessation of oral intake and the use of intravenous fluids, as is recommended in the treatment of chylous fistulas occurring elsewhere in the body. Although these are exceedingly rare, all plastic surgeons doing breast reconstruction should be aware of chylous fistulas and their treatment.
Isolated chylopericardium is a rare entity with an obscure aetiology. "Cardiomegaly" was discovered incidentally in a 40 year old woman and was found to correspond to chylopericardium. The patient was referred to us after a failed attempt of left pericardio-pleural fenestration. Lymphography revealed injection of the left anterior mediastinal lymph node chain from the arch of the thoracic duct. At operation, the chylous leaks were sutured from this chain. Anatomical study of the lymphatic drainage of the heart revealed interconnections between the left anterior mediastinal, left recurrent, left suprabronchial lymph node chains and the thoracic duct. A review of the literature confirmed that chylous leak generally occurs from this lymphatic system when the cases reported have been investigated by lymphangiography or explored surgically.
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A rare case of lymphangiomatosis without pulmonary involvement is reported. The diagnosis was based on the presence of multifocal lesions and histological examination. Retroperitoneal lesions were responsible for chyluria, which was treated surgically. Chyluria is an exceptional complication of this disease, as only 3 such cases have been reported in the literature. The presence of cutaneous signs raises the question of the relations between lymphangiomatosis and Bourneville's tuberous sclerosis.
A 5-year-old girl admitted to our hospital complaining cardiomegaly due to pericardial fluid and punched-out area in the humerus. Analysis of pericardial fluid confirmed primary chylopericardium and the findings in the humerus suggested skeletal lymphoangiomatosis. Despite medical treatments, pericardial fluid didn't decrease. Therefore, she underwent ligation and resection of thoracic duct. She recovered uneventfully without reaccumulation of the pericardial effusion. In addition, skeletal survey resulted in lymangiomatosis.
The case history of a young asymptomatic patient with primary chylous pericardium is reported. On the basis of this case and those reported in the literature, we suggest that diagnosis should be established by echocardiograms, cardiac angiograms, and pericardiocentesis. Lymphangiograms are useful for the detection of the underlying abnormality of the lymph vessels. Pericardiectomy together with thoracic duct ligation are suggested as the preferred treatment. We propose that generalized lymphatic abnormality is the underlying mechanism of this entity. This lymphatic abnormality could be associated with impaired cellular immunity, although no such impairment was found in our patient.
A 54-year-old male was referred to our outpatient clinic because of milky urine. He had lived in Kumamoto, an area of endemic filariasis. There were no microfilaria found in his blood smear. Lymphangiography showed dilation of the retroperitoneal lymphatics and bilateral renal refluxes. The thoracic duct was obvious. The initial treatment consisted of irrigating the bilateral renal pelvis with silver nitrate solution, but was not successful and recurrent acute urinary retention developed. Therefore, we performed stripping and ligation of the bilateral renal lymphatics. Chyluria disappeared immediately after surgery. The etiology and various treatments for chyluria are discussed.
Chyluria is the passage of chylus into urine resulting in fistulization through the lymphatic system and the urinary system. This rare condition is usually caused by filaria infestation or malformations, neoplasia or trauma. We report a case of a 18-year-old man. The patient presented milky urine which had appeared after angiography following minor leg trauma. Physical examination revealed asymmetry of the face and cutaneous dyschromia. Blood tests revealed hypogammaglobulinemia and altered CD4/CD8 ratio (0.6). Urine tests showed proteinuria (30 mg/dl), lipiduria (triglycerides 750 mg/dl) and density of 1025. Renal function was normal. Abdomen computed tomography and urography were normal. Cystoscopy revealed the presence of milky urine in the bladder and selective catheterization revealed that the origin was the right ureter alone. Ascendent pyelography did not reveal any malformation of the urinary tract; but after this the chyluria spontaneously disappeared. The patient was rehospitalized 3 months later for recurrence. Lymphography was then performed and revealed a dilated lymphatic network with minute lacunar images projecting into the right kidney. Chyluria again disappeared spontaneously and recurred sporadically over the next two years in a patient who remained in good physical condition. The etiology of chyluria in a patient without filaria infestation is problematic, particularly when the most common causes (tuberculosis, neoplasia, trauma) are excluded as in our case. The asymmetry of the face, together with cutaneous dyschromia and the presence of a subarachnoidea cyst in the right temporal region suggested our patient had multiple congenital malformations.
Duplications of the digestive tract are very unusual entities that can be located in any other part of the Gastrointestinal tract. However the most frequent location is the jejunoileal one. We report the case of a giant chylous intestinal cyst duplication, located in the ileum, diagnosed in a 41 year-old man.
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