American Journal of Internal Medicine

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Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Received: 23 July 2019    Accepted: 21 August 2019    Published: 04 September 2019
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Abstract

The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.

DOI 10.11648/j.ajim.20190705.12
Published in American Journal of Internal Medicine (Volume 7, Issue 5, September 2019)
Page(s) 118-123
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Chylopericardium, Cardiac Tamponade, Lymphangiography, Pericardiocentesis

References
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Author Information
  • Division of Internal Medicine, Emergency Hospital “Dr. Clemente Alvarez”, Santa Fe, Argentina; Department of Human Physiology, National University of Rosario, Santa Fe, Argentina

  • Division of Internal Medicine, Emergency Hospital “Dr. Clemente Alvarez”, Santa Fe, Argentina

  • Division of Cardiology, Emergency Hospital “Dr. Clemente Alvarez”, Santa Fe, Argentina

  • Division of Internal Medicine, Emergency Hospital “Dr. Clemente Alvarez”, Santa Fe, Argentina

  • Division of Internal Medicine, Emergency Hospital “Dr. Clemente Alvarez”, Santa Fe, Argentina

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  • APA Style

    Gabriel Aranalde, Román Martinez Lorenzin, Martín Cánaves, Cielo Gomez, Domingo Cera. (2019). Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade. American Journal of Internal Medicine, 7(5), 118-123. https://doi.org/10.11648/j.ajim.20190705.12

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    ACS Style

    Gabriel Aranalde; Román Martinez Lorenzin; Martín Cánaves; Cielo Gomez; Domingo Cera. Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade. Am. J. Intern. Med. 2019, 7(5), 118-123. doi: 10.11648/j.ajim.20190705.12

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    AMA Style

    Gabriel Aranalde, Román Martinez Lorenzin, Martín Cánaves, Cielo Gomez, Domingo Cera. Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade. Am J Intern Med. 2019;7(5):118-123. doi: 10.11648/j.ajim.20190705.12

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  • @article{10.11648/j.ajim.20190705.12,
      author = {Gabriel Aranalde and Román Martinez Lorenzin and Martín Cánaves and Cielo Gomez and Domingo Cera},
      title = {Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade},
      journal = {American Journal of Internal Medicine},
      volume = {7},
      number = {5},
      pages = {118-123},
      doi = {10.11648/j.ajim.20190705.12},
      url = {https://doi.org/10.11648/j.ajim.20190705.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajim.20190705.12},
      abstract = {The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade
    AU  - Gabriel Aranalde
    AU  - Román Martinez Lorenzin
    AU  - Martín Cánaves
    AU  - Cielo Gomez
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    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
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    EP  - 123
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20190705.12
    AB  - The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.
    VL  - 7
    IS  - 5
    ER  - 

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