Chylopericardium In a Young Woman Revealing A Mediastinal Cystic Lymphangioma: A Case Report

Isolated chylopericardium due to mediastinal cystic lymphangioma is a rare entity. We report a case of asymptomatic chylopericardium in an 18 years old female with no history of trauma, thoracic surgery, malignancy, infection, or tuberculosis sand who presented with cardiomegaly noticed on chest x-ray before surgery of mandibular subluxation. Echocardiography showed a large number of pericardial effusions and pericardiocentesis yielded 1.25 L of milky-colored fluid which showed a triglyceride level of 4.82 g/L and cholesterol of 0.29 g/L with a cholesterol to triglyceride ratio of <1, characteristic of the chylous fluid. Chest computed tomography showed a huge mediastinal cystic lymphangioma. The patient successfully responded to continuous pericardial drainage and a medium-chain triglyceride diet then she was referred to the thoracic department for surgery. This type of case risks being misdiagnosed as tuberculosis, especially in countries where tuberculosis is endemic. Therefore, assessing pericardial fluid for chyle is crucial.