A Rare Occurrence of Chylopericardium in a Case of Anterior Mediastinal Mass

TL;DR

A rare case of chylopericardium caused by lung cancer is managed successfully with drainage and diet.

Contribution

This paper presents a rare clinical case of chylopericardium secondary to lung adenocarcinoma and its successful management.

Findings

Chylopericardium was diagnosed in a patient with right lung adenocarcinoma and pericardial effusion.

Pericardiocentesis and medium-chain triglyceride diet improved the patient's condition significantly.

The case emphasizes the importance of prompt diagnosis and conservative management in rare oncological presentations.

Abstract

A middle-aged gentleman presented with dyspnea and hypotension, accompanied by an anterior mediastinal mass infiltrating the anterior chest wall and a moderate to large pericardial effusion, which upon evaluation revealed chylous fluid. Further investigation diagnosed him with right lung adenocarcinoma infiltrating the chest wall, staged at T4N3M1. The patient subsequently developed cardiac tamponade, necessitating immediate medical intervention.

Management of the patient's cardiac tamponade involved pericardiocentesis via an indwelling pericardial catheter, allowing continuous drainage of the chylous fluid. Additionally, the patient was placed on a medium-chain triglyceride diet (MCTD) to reduce chyle production. These interventions resulted in significant symptomatic improvement, stabilizing the patient's hemodynamic status, and alleviating the immediate life-threatening condition.

This case highlights the clinical challenges posed by rare presentations such as chylopericardium secondary to malignancy and emphasizes the importance of comprehensive diagnostic evaluation and prompt therapeutic management. The successful outcome, achieved through a combination of pericardial drainage and dietary modifications, underscores the critical role of a conservative approach in managing complex oncological cases with acute complications.

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