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• W2980761279 abstract "SESSION TITLE: Case Report Semifinalists 8 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Chylopericardium is a rare disorder in which lymphatic fluid accumulates within the pericardial space [1]. The fluid collection may cause significant change in pericardial pressure compromising normal cardiac physiology [3]. We present a case of secondary chylopericardium causing cardiac tamponade in a 33-year-old female patient during her late second trimester of pregnancy. CASE PRESENTATION: A 33-year-old female at 27 weeks gestation presented to our hospital with vaginal bleeding and shortness of breath. She has a significant past medical history of pre-eclampsia. She described progressive dyspnea prior to admission and was prompted to come to the emergency department for vaginal bleeding. Initial evaluation revealed active preterm labor with a single, live intrauterine pregnancy in breech position with a 20-30% placental abruption. The patient was severe tachypneic, saturating 90% on room air. Chest x-ray demonstrated bilateral pulmonary edema and an enlarged cardiac silhouette (Fig. 1). Point-of-care ultrasound (POCUS) was utilized to investigate respiratory insufficiency and revealed a large pericardial effusion with tamponade physiology (Fig. 2). The decision was made by our multidisciplinary team to perform an emergent cesarean section followed by a diagnostic pericardiocentesis which removed 450mL of white, opaque fluid (Fig. 3). Fluid analysis demonstrated high levels of triglycerides (753 mg/dl) without significant cellular components. The fluid was determined to be chylous in nature as cultures were unremarkable and pathology was negative for malignancy. Two days following delivery, the pericardial effusion reaccumulated requiring the placement of a thoracostomy tube which continued to drain chylous fluid over several days. The patient underwent lymphangiography which revealed the source of effusion to be a ruptured lymphangioma. The patient improved with supportive therapy; thoracostomy tubes were removed after drainage ceased and patient was discharged home with significant improvement of her respiratory status. DISCUSSION: Chylopericardium has the potential to cause cardiac tamponade. Symptomatology can be acute or subacute based on the rate of increase in intrapericardial pressure [2]. Complications in pregnancy such as preeclampsia can disguise the typical Beck’s triad of cardiac tamponade, however POCUS may be utilized to rapidly visualize cardiac anatomy and diagnose pericardial effusion. Literature review reveals various etiologies of secondary chylopericardium with therapy directed at root cause. We suspect changes in abdominal anatomy during pregnancy resulted in the insidious accumulation of chylous fluid within the lymphangioma causing rupture and drainage into the pericardium [1-3]. CONCLUSIONS: Chylopericardium with tamponade physiology is a rare complication of pregnancy. Bedside ultrasound is an invaluable tool to rapidly diagnosis this potential lethal pathology. Reference #1: Kwon,J.B., Choi, S.Y., Kim, C.K., & Park, C.B. (2013). Primary idiopathic silent chylopericardium. Journal of Cardiothoracic Surgery, 8 (1). https://doi.org/10.1186/1749-8090-8-28 Reference #2: Spodick, D.H. (2003). Acute Cardiac Tamponade. New England Journal of Medicine, 349 (7), 684-690. Doi:10.1056/nejmra022643 Reference #3: Vakamudi, S., Ho, N., Cremer, PC. (2017). Pericardial Effusions: Causes, Diagnosis, and Management.Progress in Cardiovascular Diseases, 59 (4), 380-388. https://doi.org/10.1016/j.pcad.2016.12.009 DISCLOSURES: No relevant relationships by Michael Girard, source=Web Response No relevant relationships by Daniel Gomez, source=Web Response No relevant relationships by Alex Morizio, source=Web Response No relevant relationships by Sigmund Paczkowski, source=Web Response No relevant relationships by Benjamin Phelps, source=Web Response" @default.
• W2980761279 created "2019-10-25" @default.
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• W2980761279 date "2019-10-01" @default.
• W2980761279 modified "2023-09-27" @default.
• W2980761279 title "CHYLOPERICARDIUM CAUSING CARDIAC TAMPONADE IN A YOUNG PREGNANT WOMAN" @default.
• W2980761279 doi "https://doi.org/10.1016/j.chest.2019.08.173" @default.
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