TY - JOUR
T1 - Isolated primary chylopericardium
T2 - A rare case report and literature review
AU - Putra, Muhammad Arza
AU - Grantomo, Jonathan
AU - Melisa, Stefanie
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/11
Y1 - 2022/11
N2 - Introduction: Primary chylopericardium is an extremely rare disease with no previous reported case in Indonesia. It may be caused by an abnormality of lymphatic drainage in the thoracic region. Case presentation: We report the case of a 19-year-old female who presented with a chief complaint of shortness of breath and fluid accumulation in her pericardial sac. Screening for autoimmune disease, tuberculosis, and malignancy all came back negative. Lymphoscintigraphy showed suspected leakage or obstruction of lymph at the supradiaphragmatic level. The patient was diagnosed with primary chylopericardium. In a span of 1 year, she had undergone 3 pericardiocentesis procedures and declined surgical treatment. On her fourth pericardiocentesis, the cardiologists were unable to remove fluid from the pericardial sac. Thoracic duct ligation and pericardial window were eventually performed and a total of 850 ml of chylous fluid was removed. At 6 months postoperation patient showed no signs and symptoms of pericardial effusion and was in good condition. Discussion: Constrictive pericarditis can occur as a complication of chronic inflammation in the pericardium due to the presence of chylopericardium and a history of multiple pericardiocenteses. However, there are no reports regarding the exact duration of chylopericardium that will lead to constrictive pericarditis. Difficulty in pericardiocentesis might be an early sign of scarring in the pericardium. Conclusion: Delayed surgical treatment of chylopericardium increases the risk of constrictive pericarditis and significantly reduces the patient's quality of life due to recurrent symptoms and hospitalizations.
AB - Introduction: Primary chylopericardium is an extremely rare disease with no previous reported case in Indonesia. It may be caused by an abnormality of lymphatic drainage in the thoracic region. Case presentation: We report the case of a 19-year-old female who presented with a chief complaint of shortness of breath and fluid accumulation in her pericardial sac. Screening for autoimmune disease, tuberculosis, and malignancy all came back negative. Lymphoscintigraphy showed suspected leakage or obstruction of lymph at the supradiaphragmatic level. The patient was diagnosed with primary chylopericardium. In a span of 1 year, she had undergone 3 pericardiocentesis procedures and declined surgical treatment. On her fourth pericardiocentesis, the cardiologists were unable to remove fluid from the pericardial sac. Thoracic duct ligation and pericardial window were eventually performed and a total of 850 ml of chylous fluid was removed. At 6 months postoperation patient showed no signs and symptoms of pericardial effusion and was in good condition. Discussion: Constrictive pericarditis can occur as a complication of chronic inflammation in the pericardium due to the presence of chylopericardium and a history of multiple pericardiocenteses. However, there are no reports regarding the exact duration of chylopericardium that will lead to constrictive pericarditis. Difficulty in pericardiocentesis might be an early sign of scarring in the pericardium. Conclusion: Delayed surgical treatment of chylopericardium increases the risk of constrictive pericarditis and significantly reduces the patient's quality of life due to recurrent symptoms and hospitalizations.
KW - Constrictive pericarditis
KW - Pericardial window
KW - Primary chylopericardium
KW - Thoracic duct ligation
UR - http://www.scopus.com/inward/record.url?scp=85140206997&partnerID=8YFLogxK
U2 - 10.1016/j.ijscr.2022.107764
DO - 10.1016/j.ijscr.2022.107764
M3 - Article
AN - SCOPUS:85140206997
SN - 2210-2612
VL - 100
JO - International Journal of Surgery Case Reports
JF - International Journal of Surgery Case Reports
M1 - 107764
ER -