Abstract
This is a novel case of idiopathic chylopericardium and chylothorax in a young gentleman with good past health. He first presented with dyspnea due to idiopathic chylopericardium, which was refractory to medical and surgical treatments, including medium chain triglyceride diet, octreotide, and video-assisted pericardial window. Chylopericardium persisted and progressed to concomitant left-sided chylothorax. He subsequently went through multiple imaging studies, including lymphoscintigraphy and an intranodal lymphangiogram, both of which confirmed a leakage in the thoracic duct. Finally, thoracic duct embolisation was performed via retrograde transvenous approach, which was successful with durable results. Idiopathic chylopericardium and chylothorax is extremely rare, but this case illustrates that it is an entity that can greatly impact the patient’s quality of life if left undiagnosed and untreated. While surgery can relieve cardiac tamponade, lymphatic imaging and intervention was key in diagnosing and treating the root cause of the condition. This case highlights the importance of multidisciplinary efforts in managing rare cases, and how interventional radiology offers a minimally invasive but effective way of treating thoracic duct leakage. Retrograde thoracic duct embolisation is technically challenging but safe and effective.