Chylopericardium and cholesterol pericarditis
- Brian D Hoit, MD
Brian D Hoit, MD
- Professor of Medicine and Physiology and Biophysics
- Case Western Reserve University and University Hospitals of Cleveland
A pericardial effusion is the accumulation of fluid within the pericardial sac surrounding the heart that exceeds the small amount that is normally present (typically less than 50 cc). Pericardial effusion can develop in patients with virtually any condition that affects the pericardium, including acute pericarditis and a variety of systemic disorders. Chylopericardium (pericardial effusion composed of chyle) and cholesterol pericarditis (pericardial inflammation resulting from pericardial effusion with cholesterol crystals and other inflammatory cells) will be reviewed here. Other causes of pericardial effusion and pericarditis are discussed separately. (See "Etiology of pericardial disease" and "Diagnosis and treatment of pericardial effusion", section on 'Etiology'.)
Chylothorax, with or without chylopericardium, is much more common than isolated chylopericardium. Most cases are nontraumatic, with the major cause being malignancy, although inadvertent surgical trauma is also a common cause. Chylothorax is discussed separately. (See "Etiology, clinical presentation, and diagnosis of chylothorax".)
Chylopericardium is a pericardial effusion comprised of chyle, the normal content of the lacteals (lymphatics of the small intestine) and thoracic duct (figure 1). Chylopericardium may be primary (idiopathic) or, much more often, secondary. The pericardial effusion appears milky white and opaque, with a triglyceride level greater than 500 mg/dL (5.65 mmol/L) and a cholesterol/triglyceride ratio less than 1.
Although the cholesterol content is high, chylopericardium should not be confused with cholesterol pericarditis in which the fluid contains cholesterol crystals, foam cells, macrophages and giant cells. The fluid in cholesterol pericarditis is clear and classically is said to have a glittering "gold paint" appearance, although many other colors have been described .
Chylopericardium is a rare disorder that may be primary (ie, idiopathic) or, more often, secondary to injury to the thoracic duct. The thoracic duct carries chyle from the intestinal tract to the blood stream (figure 1). Although wide anatomic variation exists, in most persons the thoracic duct passes in relatively close proximity to the pericardium over its course from the cisterna chyli to the jugular and subclavian veins. (See "Etiology, clinical presentation, and diagnosis of chylothorax", section on 'Anatomy of the thoracic duct'.)
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