Idiopathic Thoracic Duct Stenosis Causing Chylopericardium: Report of a Case

原發性乳糜管狹窄引起心包膜乳糜腫：病例報告

許立民(Li-Ming Hsu) ； 鄭伯智(Po-Chih Cheng)

《Formosan Journal of Surgery》 39卷1期 (2006/02) Pp. 43-47

https://doi.org/10.29833/FJS.200602.0008

摘要

心包乳糜腫是臨床上罕見的疾病，其可分為原發與繼發性兩種。原發性其病因不甚清楚，繼發性可因心臟手術或外傷或縱隔腔腫瘤而造成。近幾年來，有一些報告指出，雖然原發性的心包乳糜腫病因不甚清楚，但乳糜管的異常仍是其最有可能的原因。
我們報告一病例為18歲年輕健康男性，在健康檢查中於胸部X光片發現心臟擴大，經心臟超音波及心包膜穿刺而被診斷為心包乳糜腫。淋巴攝影中顯示乳糜管進入左鎖骨下靜脈處有狹窄，於保守治療無效後，我們施行手術處理，我們將乳糜管狹窄處切除，重新接合於左下鎖骨下靜脈，此外合併施行心包膜切開術。所有手術均經左側開胸，術後二個月追蹤不再有心包乳糜積液的發生。相關文獻的回顧亦一併討論。

並列摘要

Chylopericardium, a condition in which chylous fluid accumulates in the pericardial cavity, can be primary, or secondary to cardiac surgery or trauma. In recent years, a few reports have been published, in which an abnormality in the lymphatic system is presumed to be the cause of primary chylopericardium.
Here we report a case of such chylopericardium occurring in a previously healthy 18- year-old man. Although there was no history of trauma, infection or neoplasm, he was found to have an enlarged cardiac silhouette. Primary chylopericardium was diagnosed when pericarcliocentesis yielded characteristic milky-white fluid. The thoracic duct was identified preoperatively by lymphangiography, which showed stenosis in the brachiomediastinal area near the left subclavian vein. The chylopericardium was unresponsive to conservative treatment with pericardial drainage and medium chain triglyceride diet. Re-anastomosis of the thoracic duct into the left subclavian vein with establishment of a pericardial window through a left thoracotomy was performed. After the operation, no more milky-white fluid was found in the pericardial space. The present case is probably the first one treated by the thoracic duct reconstruction described in this communication via thoracotomy. A brief review of the literature is presented.

並列關鍵字

chylopericardium ； pericardial effusion ； thoracic duct