[Chylopericardium following pulmonary tuberculosis].

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.