Deutsche medizinische Wochenschrift (1946) · 2006
[Chylopericardium following pulmonary tuberculosis].
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Wieshammer S, Gorissen B, Kiefer T
Аннотация
HISTORY: A 22-year old man was admitted with a large pericardial effusion after he had been successfully treated for tuberculosis of the right lung for 6 months. Treatment had been discontinued according to plan 4 months before the current admission. The patient was only mildly symptomatic with exertional dyspnea of 3 weeks duration. Body temperature, pulse rate and blood pressure were within normal limits. The neck veins were not distended.
INVESTIGATIONS AND DIAGNOSIS: Laboratory data were unremarkable. The patient underwent thoracoscopy for pericardial drainage. A large chylous effusion was removed.
CLINICAL COURSE: Drainage ceased over the following months after the patient had been on a medium-chain triglyceride diet. On follow-up 9 months later, the patient was asymptomatic and without evidence of cardiopulmonary disease.
CONCLUSION: We presume (A) that the tuberculous infection had affected the mediastinal lymph nodes and (B) that the fibrous contraction of perinodal tissue caused a temporary obstruction of the thoracic duct at a later stage in the course of the healing process with subsequent reflux of chyle into the pericardial cavity via lymphatic vessels that normally drain the pericardium.
INVESTIGATIONS AND DIAGNOSIS: Laboratory data were unremarkable. The patient underwent thoracoscopy for pericardial drainage. A large chylous effusion was removed.
CLINICAL COURSE: Drainage ceased over the following months after the patient had been on a medium-chain triglyceride diet. On follow-up 9 months later, the patient was asymptomatic and without evidence of cardiopulmonary disease.
CONCLUSION: We presume (A) that the tuberculous infection had affected the mediastinal lymph nodes and (B) that the fibrous contraction of perinodal tissue caused a temporary obstruction of the thoracic duct at a later stage in the course of the healing process with subsequent reflux of chyle into the pericardial cavity via lymphatic vessels that normally drain the pericardium.