Chylopericardium refers to existing communication between the pericardial sac and the thoracic duct carrying the chyle. The objective of our report was to highlight the specificity of diagnosis and treatment of this rare but tedious condition through the analysis of two case reports. Male patient, aged 63 years, with
chylopericardium was diagnosed perioperatively (implantation of artificial aortic--St. Jude No 21 and mitral valve--St. Jude No 29). Etiology of
pericardial effusion was established by
Sudan III staining of punctate specimen obtained by subxiphoid pericardial
puncture. Probable cause of
chylopericardium was the lesion of ductus thoracicus during cross-clamping of the superior caval vein with a Cooley clamp. Initial treatment included diet rich in medium-chain
triglycerides which resulted in resolution of the effusion. During five-year follow-up, there were no recurrences of
pericardial effusion. The second patient was female, 21 years old, with
chylopericardium after partial
pericardiectomy performed because of the chronic severely symptomatic
pericardial effusion, resistant to other forms of treatment. Pericardiocentesis provided 650 ml of yellowish fluid with a high concentration of
cholesterol (3.2 mmol/l),
triglycerides (16.6 mmol/l), and
proteins (64.7 g/l), which verified
chylopericardium, most probably as a consequence of the lesion of ductus thoracicus during partial
pericardiectomy. Diet rich in medium-chain
triglycerides failed to decrease the effusion, after two weeks of treatment (daily secretion 250-350 ml). Lymphography revealed lesion of ductus thoracicus, most probably at Th9/Th10 level, with no direct visualization of extravasal accumulation of
contrast media. Surgical
ligation of ductus thoracicus was performed through the right
thoracotomy. However, postoperative secretion increased to 1000 ml/day. Patient underwent redo surgery comprising the
ligation of lymphatic vessels, guided by extravasation of intraoperatively iwected
methylene-blue indicator. During one-year follow-up, there were no recurrences of
pericardial effusion. In conclusion, intraoperative lymphography significantly contributed to successful surgical treatment of patients with
chylopericardium.