Case Reports| Volume 48, ISSUE 6, P1434-1437, June 2013

Transabdominal ligation of the thoracic duct with pericardial-peritoneal shunting in a case of primary idiopathic chylous pericardial effusion


      Primary chylous pericardial effusion is a rare entity with few cases reported so far. We report a case of idiopathic etiology in a previously healthy 16-year-old boy. The patient presented with intermittent chest pain and dizziness caused by a chronic pericardial effusion. An echocardiogram revealing a pericardial effusion and open pericardiocentesis with a drainage of approximately of 500 ml of chylous fluid established the diagnosis. Patient had no history of trauma, cardiac surgery, central insertion of subclavian catheters or blunt injury. Computed tomography ruled out malignancies in the abdomen and chest. Clinical, laboratory and radiological investigations for the possible underlying cause of the condition were not determined. Management with a dietary regimen consisting of a medium-chain triglyceride-rich diet, octreotide pharmacological treatment and initial subxiphoid resection with pericardial tube drainage was unsuccessful. Surgical approach was required consisting of pericardio-peritoneal window with trans-abdominal ligation (clipping) of the thoracic duct above the diaphragm. Postoperative outcome was uneventful and there was a rapid recovery after surgical management.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dib C.
        • Tajik A.J.
        • Park S.
        • et al.
        Chylopericardium in adults: a literature review over the past decade (1996–2006).
        J Thorac Cardiovacs Surg. 2008; 136: 650
        • Yüksel M.
        • Yildizeli B.
        • Zonüzi F.
        • et al.
        Isolated primary chylopericardium.
        Eur J Cardiothorac Surg. 1997; 12: 319
        • Svedjeholm R.
        • Jansson K.
        • Olin C.
        Primary idiopathic chylopericardium—a case report and review of the literature.
        Eur J Cardiothorac Surg. 1997; 11: 387
        • Mewis C.
        • Kühlkamp V.
        • Sokiranski R.
        • et al.
        Primary chylopericardium due to partial aplasia of the thoracic duct.
        Eur Heart J. 1997; 18: 880
        • Tchervenkov C.L.
        • Dobell A.R.
        Chylopericardium following cardiac surgery.
        Can J Surg. 1985; 28: 542
        • Akamatsu H.
        • Amano J.
        • Sakamoto T.
        • et al.
        Primary chylopericardium.
        Ann Thorac Surg. 1994; 58: 262-266
        • Dunn R.P.
        Primary chylopericardium: a review of the literature and an illustrated case.
        Am Heart J. 1975; 89: 369-377
        • De Meester T.R.
        • Lafontaine E.
        The Pleura.
        in: Gibbon's surgery of the chest. W.B. Saunders, Philadelphia1983: 369-372
        • Groves L.K.
        • Effler D.B.
        Primary chylopericardium.
        N Engl J Med. 1954; 250: 520-523
        • Mehrotra S.
        • Peeran N.A.
        • Bandyopadhyay A.
        Idiopathic chylopericardium. An unusual cause of cardiac tamponade.
        Tex Heart Inst J. 2006; 33: 249-252
        • Mikroulis D.
        • Didilis V.
        • Bitzikas G.
        • et al.
        Octreotide in the treatment of chylothorax.
        Chest. 2002; 121: 2079-2081
        • Helin R.D.
        • Angeles S.T.V.
        • Bhat R.
        Octreotide therapy for chylothorax in infants and children: a brief review.
        Pediatr Crit Care Med. 2006; 7: 576-579
        • Roehr C.C.
        • Jung A.
        • Proquitte H.
        • et al.
        Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review.
        Intensive Care Med. 2006; 32: 650-657
        • Rosti L.
        • Bini R.M.
        • Chessa M.
        • et al.
        The effectiveness of octreotide in the treatment of post-operative chylothorax.
        Eur J Pediatr. 2002; 161: 149-150
        • Charnilas Y.
        • Levo Y.
        • Weiss A.
        • et al.
        Isolated idiopathic chylopericardium.
        J Thorac Cardiovasc Surg. 1977; 73: 719-721
        • Chan B.B.K.
        • Murphy M.C.
        • Rodgers B.M.
        Management of chylopericardium.
        J Pediatr Surg. 1990; 25: 1185-1189
        • Wurnig P.N.
        • Hollaus P.H.
        • Ohtsuka T.
        • et al.
        Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax.
        Ann Thorac Surg. 2000; 70: 1662-1665
        • Allen K.B.
        • Faber L.P.
        • Warren W.H.
        Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage.
        Ann Thorac Surg. 1999; 67: 437-440
        • Morishita Y.
        • Taira A.
        • Furoi A.
        • et al.
        Constrictive pericarditis secondary to primary chylopericardium.
        Am Heart J. 1985; 109: 373-375
        • Wang N.
        • Feikes J.R.
        • Mogensen T.
        • et al.
        Pericardioperitoneal shunt: an alternative treatment for malignant pericardial effusion.
        Ann Thorac Surg. 1994; 57: 289-292
        • Molnar T.F.
        • Biki B.
        • Horvath Ö.P.
        Pericardioperitoneal shunt: further development of the procedure using VATS technique.
        Ann Thorac Surg. 2002; 74: 593-595
        • Olson J.E.
        • Ryan M.B.
        • Blumenstock D.A.
        Eleven years' experience with pericardial-peritoneal window in the management of malignant and benign pericardial effusions.
        Ann Surg Oncol. 1995; 2: 165-169
        • Kannagi T.
        • Osakada G.
        • Wakabayashi A.
        • et al.
        Primary chylopericardium.
        Chest. 1982; 81: 105-108