A Case of Chylopericardium Secondary to the Superior Vena Cava Syndrome in Behcet's Disease

Eun Jung Choi; Ja Young Son; Seung Woo Han; Gun Woo Kim; Jin Young Kang; Eun Joo Song; Eun Jung Nam; Young Mo Kang

doi:10.4078/jkra.2008.15.3.255

Journal List > J Korean Rheum Assoc > v.15(3) > 1003631

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Choi, Son, Han, Kim, Kang, Song, Nam, and Kang: A Case of Chylopericardium Secondary to the Superior Vena Cava Syndrome in Behcet's Disease

Original Article

J Korean Rheum Assoc 2008;15(3):255-260.

Published online: 20 September 2008

DOI: https://doi.org/10.4078/jkra.2008.15.3.255

A Case of Chylopericardium Secondary to the Superior Vena Cava Syndrome in Behcet's Disease

Eun Jung Choi¹, Ja Young Son¹, Seung Woo Han¹, Gun Woo Kim¹, Jin Young Kang², Eun Joo Song², Eun Jung Nam², Young Mo Kang²

¹Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea

²Kyungpook National University School of Medicine, Daegu, Korea

Received 2 June 2008 Accepted 15 July 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.

Keywords: Behcet's disease, Chylopericardium, Superior vena cava syndrome

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Fig. 1.

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).

Fig. 2.

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).

Fig. 3.

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).

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