Chylopericardium and cardiac tamponade as rare complications of coronary artery bypass graft (CABG): A case report.

Introduction: Chylopericardium, a rare condition involving the accumulation of chylous fluid in the pericardial cavity, arises due to lymphatic system disruption. It is frequently linked to trauma, malignancy, or cardiothoracic surgeries. Although primarily reported in pediatric cases, its occurrence in adults, particularly following coronary artery bypass graft (CABG), is rare.

Case Presentation: We present the case of a 62-year-old male who, one week after CABG, developed progressive dyspnea, weakness, and fatigue. Physical examination revealed signs of cardiac tamponade, and echocardiography confirmed severe pericardial effusion with right ventricular collapse. Pericardial fluid analysis demonstrated chylous fluid with elevated triglycerides and protein levels, diagnosing chylopericardium-induced cardiac tamponade. Despite surgical intervention, an emergency pericardiocentesis was performed to stabilize the patient, followed by a pericardial window, thoracic duct ligation, and aggressive management with total parenteral nutrition (TPN) and albumin; however, the patient's condition deteriorated, resulting in cardiac arrest and death.

Discussion: Chylopericardium following cardiac surgery is a rare but serious complication. It typically arises from inadvertent injury to the thoracic duct during the procedure, exacerbated by increased postoperative venous pressure. Diagnosis hinges on pericardiocentesis, revealing milky fluid with high triglycerides and protein levels. While conservative treatment may suffice in minor cases, severe chylopericardium often necessitates surgical intervention. This case underscores the challenge of diagnosing this rare complication and the critical need for timely intervention.

Conclusion: This case highlights the importance of early recognition and aggressive management of post-CABG chylopericardium. Rapid deterioration, despite prompt treatment, emphasizes the need for heightened clinical awareness to prevent fatal outcomes.