interesting_case Thoracoscopic creation of pericardial window for chylous pericarditis in infant

[Gunduz Aghayev]

Pt 15 day old admitted to NICU due to RDS. FT. NSVD.

Chest XRay - Rt pleural effusion with mediastinal shift.

Pleural drainage. NPO, TPN.

After 1 week daily outcome from drainage about 20 ml\kg.

plurodesis with 4% iodine. no effect.

After 3 weeks - Rt thoracoscopic supra-diaphragmatic Thoracic duct ligation.

Uneventful recovery. Discharged with MCT formula feeding.

After 2 weeks - mild pericardial effusion ( 10 mm) on Echocardiogarphy.

After 1 month > 2 sm pericardial effusion, tachicardia.

Lt thoracoscopic creation of pericardial window done. Uneventful recovery.

[Ahmed Nabil]

Wonderful prof!
clinical, radiology and operative pictures will be appreciated

[Gunduz Aghayev]

[Dr Ammar]

What is the reason of pericardial effusion ?? If thoracic duct already lighted is it chylous pericardial effusion ???

[Gunduz Aghayev]

nice question. I was looking for answer for this question many days and found answer - retrograde lymph flow after supradiaphragmatic thoracic duct ligation can cause chylous pericardial effusion.

[Gunduz Aghayev]

Retrograde lymph flow

[Dr Ammar]

Thank you 🙏