A case of cardiac tamponade caused by chylopericardium after mediastinal lymph node dissection for recurrence of lung cancer

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  • 縦隔リンパ節郭清術後の乳糜心膜症により心タンポナーデを発症した1例

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Abstract

<p>We report a case of pericardial tamponade that occurred after mediastinal lymph node dissection. A 67-year-old man underwent a left lower lobectomy with mediastinal lymph node dissection (ND2a-2) for primary lung cancer. Two years later, chest computed tomography (CT) showed enlargement of a paratracheal lymph node, and transbronchial needle aspiration of the lymph node established a diagnosis of recurrence of squamous cell lung cancer. The patient underwent a thoracoscopic right upper mediastinal node dissection. On postoperative day 1, the drainage fluid turned milky, and a diagnosis of chylothorax was made. He received pleurodesis with OK432 and the chylothorax disappeared. Two days after the removal of the chest drainage tube, his systolic blood pressure decreased suddenly in association with sinus tachycardia. Urgent echocardiography revealed a large pericardial effusion consistent with cardiac tamponade. A drainage tube was immediately inserted into the pericardial space, and thereafter a cloudy white effusion was discharged, leading to the diagnosis of chylopericardium. Because conservative treatments were not successful, the patient underwent an operation with ligation of the thoracic ducts and pericardial fenestration. Since the operation, he has experienced no recurrence of the chylothorax or chylopericardium. Although chylopericardium after non-cardiac surgery is extremely rare, cardiac tamponade resulting from chylopericardium might be life-threatening. Therefore, thoracic surgeons should consider the possibility of this complication after surgery.</p>

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