Abstract
ABSTRACT Relevance: Chylopericardium (CPE) is characterized by lymph accumulation inside the pericardial sac. CPE can be primary or idiopathic and secondary. Secondary CPE develops after cardiac and thoracic surgery (9%), chest trauma and radiotherapy, as well as in the presence of mediastinal tumors (6%), systemic diseases, lymphatic system pathology, lymphangiomatosis and tuberculosis. Primary CPE is a diagnosis of exclusion of all the above causes. In most cases, CPE is idiopathic (56-60%). Heart tamponade is the most common complication of chylous pericarditis (38%). Currently one can find in the literature only up to 100 cases of primary CPE in children, including spontaneous CPE of neonates. The authors present a brief review of literature and a clinical case of substantial meaning for practical pediatricians, as unfortunately the right diagnosis in a child with a substantial pericardial effusion was established only after 9 years of follow-up in various hospitals. This study aimed to provide a clinical case of an adolescent with late diagnosed chylopericarditis. Materials and Methods: This article describes the clinical presentation and diagnostic findings of late-diagnosed chylopericarditis. A literature search was conducted in PubMed using keywords and medical subject headings. Results: Due to prolonged recurrence of pericardial effusion and the ineffectiveness of standard therapy, the patient underwent diagnostic pericardiocentesis, which led to a diagnosis of chylous pericarditis. A low-fat diet and octreotide therapy resulted in complete resolution of the pericardial effusion. No recurrences have been observed during a 4.5-year follow-up. Conclusion: At the time of diagnosis, chylopericarditis was assessed as idiopathic, but it was not possible to completely exclude its secondary nature, potentially associated with previous respiratory infections and a latent inflammatory process in the mediastinal organs, which justifies the need for long-term observation. Keywords: thoracic duct, lymph, pediatrics, chylous effusion, chylopericardium, heart tamponade