Ghorbani Ali, Kaveh Roxana, Rezaei Zadeh Rukerd Mohammad, Mirkamali Hanieh, Ahmadpour Fatemeh, Salajegheh Faranak
Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.
Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran.
Int J Surg Case Rep. 2024 Dec;125:110510. doi: 10.1016/j.ijscr.2024.110510. Epub 2024 Oct 23.
Chylopericardium, a rare condition involving the accumulation of chylous fluid in the pericardial cavity, arises due to lymphatic system disruption. It is frequently linked to trauma, malignancy, or cardiothoracic surgeries. Although primarily reported in pediatric cases, its occurrence in adults, particularly following coronary artery bypass graft (CABG), is rare.
We present the case of a 62-year-old male who, one week after CABG, developed progressive dyspnea, weakness, and fatigue. Physical examination revealed signs of cardiac tamponade, and echocardiography confirmed severe pericardial effusion with right ventricular collapse. Pericardial fluid analysis demonstrated chylous fluid with elevated triglycerides and protein levels, diagnosing chylopericardium-induced cardiac tamponade. Despite surgical intervention, an emergency pericardiocentesis was performed to stabilize the patient, followed by a pericardial window, thoracic duct ligation, and aggressive management with total parenteral nutrition (TPN) and albumin; however, the patient's condition deteriorated, resulting in cardiac arrest and death.
Chylopericardium following cardiac surgery is a rare but serious complication. It typically arises from inadvertent injury to the thoracic duct during the procedure, exacerbated by increased postoperative venous pressure. Diagnosis hinges on pericardiocentesis, revealing milky fluid with high triglycerides and protein levels. While conservative treatment may suffice in minor cases, severe chylopericardium often necessitates surgical intervention. This case underscores the challenge of diagnosing this rare complication and the critical need for timely intervention.
This case highlights the importance of early recognition and aggressive management of post-CABG chylopericardium. Rapid deterioration, despite prompt treatment, emphasizes the need for heightened clinical awareness to prevent fatal outcomes.
乳糜性心包炎是一种罕见病症，表现为心包腔内积聚乳糜液，由淋巴系统破坏引起。它常与创伤、恶性肿瘤或心胸外科手术相关。虽然主要报道于儿科病例，但在成人中发生，尤其是冠状动脉旁路移植术（CABG）后，较为罕见。
我们报告一例62岁男性患者，在CABG术后一周出现进行性呼吸困难、虚弱和疲劳。体格检查发现心脏压塞体征，超声心动图证实严重心包积液伴右心室塌陷。心包液分析显示乳糜液，甘油三酯和蛋白质水平升高，诊断为乳糜性心包炎所致心脏压塞。尽管进行了手术干预，但仍进行了紧急心包穿刺术以稳定患者病情，随后进行了心包开窗术、胸导管结扎术，并采用全胃肠外营养（TPN）和白蛋白进行积极治疗；然而，患者病情恶化，导致心脏骤停并死亡。
心脏手术后的乳糜性心包炎是一种罕见但严重的并发症。它通常源于手术过程中胸导管的意外损伤，术后静脉压升高使其加重。诊断依赖于心包穿刺术，显示出甘油三酯和蛋白质水平高的乳状液。虽然在轻症病例中保守治疗可能足够，但严重的乳糜性心包炎通常需要手术干预。本病例强调了诊断这种罕见并发症的挑战以及及时干预的迫切需求。
本病例突出了早期识别和积极处理CABG术后乳糜性心包炎的重要性。尽管及时治疗，但病情迅速恶化强调了提高临床意识以预防致命后果的必要性。
