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Curso de Atualização em Medicina Cardiovascular 2019
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A. Basics
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01. History of Cardiology
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03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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The enigmatic case of chylopericardium: A complex therapeutic approach
Session:
SESSÃO DE CASOS CLÍNICOS DE MIOCARDIOPATIAS, VALVULOPATIAS, DOENÇAS DO PERICÁRDIO, CARDIOPATIAS CONGÉNITAS
Speaker:
Joana Simões de Azevedo Massa Pereira
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Joana Simões de Azevedo Massa Pereira; Sofia Andraz; Lucas Hamann; Miguel Espírito Santo; Daniela Carvalho; Hugo Alex Costa; Dina Bento; Carlos Branco; Rita Lopes; Paulo Donato; João Pedro Moura Guedes; Jorge Mimoso
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Chylopericardium is a rare condition with chylous fluid accumulating in the pericardial space, either idiopathic or secondary. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A 58-year-old male with a history of dilated cardiomyopathy, CRT-D implantation, myocardial infarction and stroke, presented with fatigue, dyspnea, weight loss, and morning edema of the face and limbs. Echocardiography revealed a large pericardial effusion, leading to an emergency referral. Despite the absence of tamponade signs, echocardiography revealed a massive pericardial effusion with a thickness of 46mm under the right cavities, in the subcostal window, leading to partial chamber collapse during diastole.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pericardiocentesis revealed a chylopericardium and concurrent pleural effusion, which required thoracentesis, showed a chylothorax. Computed tomography<strong> </strong>detected a stenosis of left brachiocephalic trunk, likely linked to the electrocatheters, with exuberant collateral mediastinal circulation. Lymphoscintigraphy showed thoracic duct obstruction.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Consultations with vascular and cardiac surgery deemed an endovascular approach too risky due to complications and limited efficacy. Surgery was deferred given high risks from collateral circulation. The patient received octreotide, a low-fat diet with medium-chain triglycerides, and regular monitoring, but conservative measures failed, necessitating another pericardiocentesis six weeks later. Thoracic duct embolization was attempted but could not proceed due to lack of opacification on lymphangiography.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After further multidisciplinary review, CRT-D electrodes were removed, and a pleuropericardial window was created via thoracotomy. After discharge, he developed dyspnea with detection of a large pleural effusion, requiring thoracentesis and further drainages. Attempts to embolize the thoracic duct and unblock brachiocephalic trunks were unsuccessful, leading to placement of a long-term pleural drain. The patient remains stable, with periodic drainages.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This case illustrates the therapeutic challenges of secondary chylopericardium with two underlying mechanisms. Conservative treatment proved ineffective, as is commonly observed, and a less invasive approach with intermittent drainage was chosen due to patient's comorbidities and anatomy, though it requires frequent healthcare interaction and carries infection risks.</span></span></p>
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