title: Cystic lymphangioma of pericardium presenting as isolated chylopericardium - a case report.
abstract: Isolated chylopericardium due to cystic lymphangioma of pericardium is a rare entity. We report a case of asymptomatic chylopericardium in a young male who presented with cardiomegaly. Echocardiography revealed massive pericardial effusion without tamponade. Pericardiocentesis yielded 1.25 L of tea-colored fluid which showed triglyceride level of 1723 mg/dL and cholesterol of 1021 mg/dL with a cholesterol to triglyceride ratio of <1, characteristic of chylous fluid. Lymphoscintigraphy using 99Tc demonstrated lymphatic leak around the heart region. Fusion of MRI images with lymphoscintigraphy was taken with a view of localizing the leak site; it demonstrated enhancement in the pericardial space. Surgery was done via right lateral thoracotomy. Thoracic duct was ligated above diaphragm and pericardial window created by anterior pericardiectomy. The patient had an uneventful recovery and was well after 6 months of follow up. Pericardial biopsy showed cystic lymphangioma of pericardium.
authors.affiliation: Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India.
authors.forename: D
authors.initials: D
authors.lastname: Vinayakumar
authors.affiliation: Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India.
authors.forename: G
authors.initials: G
authors.lastname: Arunkumar
authors.affiliation: Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India.
authors.forename: C G
authors.initials: CG
authors.lastname: Sajeev
authors.affiliation: Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India.
authors.forename: G
authors.initials: G
authors.lastname: Rajesh
authors.affiliation: Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India.
authors.forename: Kader
authors.initials: K
authors.lastname: Muneer
authors.affiliation: Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India.
authors.forename: V
authors.initials: V
authors.lastname: Haridasan
authors.affiliation: Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India.
authors.forename: K
authors.initials: K
authors.lastname: Babu
authors.affiliation: Professor and HOD, Department of Cardiology, Govt. Medical College, Kozhikode 673008, Kerala, India. Electronic address: kedaram@gmail.com.
authors.forename: M N
authors.initials: MN
authors.lastname: Krishnan
mesh_terms: D000293:Adolescent; D006332:Cardiomegaly / Q000175:diagnosis; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D018191:Lymphangioma, Cystic / Q000175:diagnosis* / Q000601:surgery; D061305:Lymphoscintigraphy / Q000379:methods; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000601:surgery; D010492:Pericardiectomy / Q000379:methods; D020519:Pericardiocentesis / Q000379:methods; D010496:Pericardium / Q000473:pathology*; D013902:Radiography, Thoracic / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Cystic lymphangioma; Isolated chylopericardium; Lymphoscintigraphy