jkra The Journal of the Korean Rheumatism Association J Korean Rheum Assoc 1226-8070 2233-4718 The Korean Rheumatism Association 10.4078/jkra.2008.15.3.255 jkra-15-255 Original Article A Case of Chylopericardium Secondary to the Superior Vena Cava Syndrome in Behcet's Disease ChoiEun Jung 1 SonJa Young 1 HanSeung Woo 1 KimGun Woo 1 KangJin Young 2 SongEun Joo 2 NamEun Jung 2 KangYoung Mo 2 Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea Kyungpook National University School of Medicine, Daegu, Korea 09 2008 20 09 2008 15 3 255 260 02062008 15072008 Copyright © 2008 The Korean Rheumatism Association 2008 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Behcet's disease (BD) is a chronic inflammatory disorder associated with oral aphthous ulcer, genital ulcer and uveitis. Vascular lesions in BD can affect all types and sizes of vessels. The venous thrombosis, which is uncommon feature of other vasculitis, is relatively common clinical manifestation of BD. Sometimes the cardiovascular involvement in BD results in serious complications as the leading cause of morbidity and mortality. We report a 41-year-old male patient who suffered BD and presented massive chylopericardium due to the superior vena cava (SVC) syndrome. After thrombectomy of SVC, the highly productive left-sided chylothorax and restenosis of anastomosis site at SVC had occurred, which were successfully treated by the ligation of the thoracic duct and balloon-stent angioplasty. We discussed the mechanism and treatment of chylopericardium in SVC syndrome, and the possible complications after the surgical management.

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Chest X-ray at admission showed enlargement of the cardiac shadow and blunting of both costophrenic angle (A). Computed tomography (CT) of chest revealed large pericardial effusion and both pleural effusion (B), and there was total thrombotic occlusion at below level of aortic arch (arrow) (C). We obtained chylous fluid by pericardiocentesis (D).

The chest X-ray, carried out at 6 days after thrombectomy of SVC, showed blunting of the left sided costophrenic angle (A). On the CT angiogram, the SVC had a marked reduction in the lumen (arrow head) and the left brachiocephalic vein showed total occlusion (arrow) with prominent collateral vessels (B).

Cavography showed the severe narrowing of the SVC (A). After the stent insertion with ballooning, the stenosis was disappeared and blood flow was restored (B).