Title : Rare case of tuberculous chylopericardium managed conservatively
Chylopericardium is a rare condition in which there is accumulation of chylous fluid in the pericardial cavity. Commonly it is idiopathic, postoperative, or neoplastic. Tuberculosis (TB) as a cause has infrequently been reported. Optimal management is unclear, being conservative with pericardial drainage and medium- chain triglyceride (MCT) diet, or surgical through thoracic duct ligation and/or pericardiectomy. We present a case of TB chylopericardium successfully managed with anti-TB therapy.
This is a case of a 30-year-old male, asymptomatic who presented with massive pericardial effusion on transthoracic echocardiogram (TTE) after noting to have an incidental finding of cardiomegaly on routine chest radiograph.
Patient underwent pericardiostomy revealing milky white fluid with elevated cholesterol and triglyceride counts, lymphocytosis, and negative cultures consistent with chylopericardium. Biopsy, cytology, and microbial workup including TB culture were negative. Imaging with chest computed tomography scan and lymphoscintigraphy to explore possible neoplastic or anatomic causes were unremarkable. MCT diet was initiated. Surveillance TTE after 3 months revealed reacummulation of the fluid. Adenosine deaminase testing of the fluid was done and revealed to be elevated thus anti- TB therapy was started. Thereafter, TTE monitoring revealed no recurrence and the pericardial drain was removed.
TB as a possible cause of chylopericardium should always be entertained particularly in endemic areas. Diagnosis of a treatable underlying condition may alter management, potentially avoiding unnecessary risks of surgery. While data are lacking, this case suggests that TB chylopericardium is highly responsive to anti-TB therapy.
Audience Take Away
- The case will guide the listeners in the approach to chylous pericardial effusion and its management
- It will add information to the presently lacking data on tuberculous pericardial effusion
- Management of TB pericardial effusion is highly responsive to anti- TB medication, avoiding the risk of possible complications of surgical intervention