TÇCD 2013 31st Annual Congress of Turkish Pediatric Surgical Association

Aim: Chylopericardium is characterized by accumulation of chylous fluid into the pericardial cavity. As it may occur secondary to trauma, thoracal surgery or cardiac surgery, primary cases was reported that is not known the etiology. We herein present our experience in the treatment of primary chylopericardium in the adolescent patient.

Case report: A 17-year-old male presented with intermittent chest pain and breathlessness. We learned that there was no cardiac pathology and surgical history before. While he was 10 years-old, A 2 x 3 cm hypodens cystic lesion, located in the anterior mediastinum that was compatible with thymic cyst was determined and he had followed diagnosis with thymic cyst due to asymptomatic for 6 years. Magnetic resonance imaging had shown that the cyst size was enlarged from 3 cm to 6 cm. Surgical treatment was considered due to progressively increasing of size cyst to be symptomatic. We saw that the cyst did not result from thymus and was determined between the cyst and the pericardium. The cyst aspiration was performed and then milky colored cyst fluid aspirated. A tube thoracostomy was performed by creating pericardial window. The patient was discharged postoperative 7th day, but he had presented with a complaint of dyspnea at 15th day after discharge. Tube thoracostomy was performed due to revealing massive right pleural effusion in plain chest radiography. and drained chylous fluids. After 21 days of conservative treatment, thoracoscopic ligation of the thoracic duct was performed due to failed conservative treatment. Chylous fluid drainage was continued during postoperative period. Right lateral thoracotomy was performed, and the thoracic duct was ligated and divided just above the diaphragm. They were followed to be asymptomatic without signs of recurrence of the chylopericardium and pleural effusion for 14 months.

Conclusion: PIC is a rare condition that is considerably varies from asymptomatic states to signs of cardiac tamponade in childhood. The thoracic duct should be ligated and divided absolutely just above the diaphragm for cure in all cases whether or not any abnormalities.

Amaç: Şiloperikardium perikardiyal kavite içerisine şilöz sıvı birikimi ile karakterize bir durumdur. Travmaya bağlı, toraks cerrahisi veya kardiyak cerrahiye ikincil gelişebildiği gibi etiolojisi bilinmeyen primer olgular da bildirilmiştir. Bir primer şiloperikardium olgusundaki tedavi deneyimimizi sunmak istedik.

Olgu sunumu: 17 yaşında erkek hasta göğüs ağrısı ve efor dispnesi ile başvurdu. Öyküsünde kalp hastalığı, travma ya da cerrahi olmadığı, 10 yaşındayken ön mediastende yaklaşık 2x3 cm lik timik kist tanısı aldığı ve 6 yıl asemptomatik olarak izlendiği öğrenildi. Manyetik Rezonans incelemede kist boyutunda 3 cm’den 6 cm’ye artış saptandı. Kist boyutunda büyüme ve sepmtomatik olması nedeniyle cerrahiye karar verildi. Ameliyat sırasında kistin timus kaynaklı olmadığı ve perikard ile bağlantılı olduğu görüldü. Kiste ponksiyon yapıldı ve şilöz sıvı aspire edildi. Perikardiyal pencere açılarak, göğüs tüpü yerleştirildi. Ameliyat sonrası 7. gün taburcu edildi ve 15. günde dispne yakınması başvurdu. Akciğer grafisinde sağ da sıvı saptanması üzerine tüp torakostomi uygulandı. 21 günlük konservatif tedavi süresinde şilöz sıvı kaçağının devam etmesi nedeniyle hastaya torakoskopik duktus torasikus ligasyonu uygulandı. Ligasyon sonrası takibinde şilöz vasıflı drenajı devam eden hastaya sağ torakotomi yapılarak diyaframın hemen üzerinden duktus torasikus ligasyonu uygulandı. Şilöz sıvı drenajı kesilen hasta taburcu edildi ve halen sorunsuz izlenmektedir.

Sonuç: Primer şiloperikardium çocukluk çağında asemptomatik olabilmekle beraber kardiyak tamponada neden olabilecek nadir bir durumdur. Cerrahi tedavide duktus torasikus diayframın hemen üzerinden bağlanmalıdır.