Department of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.
Saudi Med J. 2020 Mar;41(3):304-308. doi: 10.15537/smj.2020.3.24960.
Chylopericardium is a rare clinical condition in which chyle leaks into the pericardial space owing to lymphatic system derangement. It can be idiopathic or occur secondarily to another clinical condition. Optimal management is accomplished through surgical intervention to impede leaks and drain fluid. In this report, we discuss an initially asymptomatic patient with a pre-employment chest radiograph that revealed cardiomegaly. An echocardiogram revealed pericardial effusion. Medical workup was unable to determine secondary causes for effusion. Pericardiocentesis revealed milky-colored fluid with a high lymphocyte count, and a lymphoscintigraphy lymphangiogram revealed a leak into the pericardium and decreased flow through left iliac and left periaortic lymph nodes. Since the patient was asymptomatic, she was treated conservatively with diet changes, pericardial drainage, and a pericardial window procedure. This type of case risks being misdiagnosed as tuberculosis, especially in countries where tuberculosis is endemic. In such cases, assessing pericardial fluid for chyle is crucial.
乳糜性心包积液是一种罕见的临床病症，由于淋巴系统紊乱，乳糜液漏入心包腔。它可以是特发性的，也可以继发于其他临床病症。通过手术干预来阻止渗漏和引流积液可以实现最佳的治疗效果。在本报告中，我们讨论了一位最初无症状的患者，其入职前的胸部 X 光片显示心脏扩大。超声心动图显示有心包积液。医学检查未能确定积液的继发原因。心包穿刺抽出乳白色液体，淋巴细胞计数高，淋巴闪烁显像淋巴管造影显示乳糜液漏入心包，并导致左髂和左主动脉旁淋巴结的流量减少。由于患者无症状，因此采用改变饮食、心包引流和心包开窗手术进行保守治疗。这种类型的病例有被误诊为结核病的风险，尤其是在结核病流行的国家。在这种情况下，评估心包液中是否有乳糜至关重要。
