PRIMARY IDIOPATHIC CHYLOPERICARDIUM - A CASE-REPORT AND REVIEW OF THELITERATURE

Primary idiopathic chylopericardium is a rare entity with obscure etio logy. In recent years, a few reports have been published where the lym phatic leak and fistula were identified by combined lymphangiography a nd computed tomography or intraoperative thoracic ductogram. Here we r eport a case occurring in a previously healthy 51 year old woman, to o ur knowledge the first case described in Scandinavia. She presented wi th cough and dyspnea of about 1 year duration. Chest X-ray demonstrate d enlargement of the cardiac silhouette. Echocardiography revealed per icardial effusion and at puncture pericardiocentecis 760 ml of chylous fluid was evacuated. There was no history of trauma, infection or neo plasm. She underwent extensive investigations but no apparent cause of the chylous effusion could be determined. Conservative treatment with pericardial drainage and low fat (medium chain triglyceride) diet fai led. The patient was cured by surgical ligature of the thoracic duct a nd partial pericardectomy through a left anterolateral thoracotomy. At 12 months post operation she was doing well and echocardiography did not reveal any signs of recurrence. A brief review of the literature i s presented. (C) 1997 Elsevier Science B.V.