Pediatr Emerg Med J.  2024 Apr;11(2):75-81. 10.22470/pemj.2023.00906.

Cardiac tamponade with chylopericardium in a 6-year-old boy with central venous catheter: a case report

• Lee IK
• Lee JW
• Lee KH
• Kim JH
• Lee B
• Park JD

• KMID: 2554079
• DOI: http://doi.org/10.22470/pemj.2023.00906

Abstract

Cardiac tamponade (CT) is a rare but potentially lethal complication associated with central venous catheters (CVCs). We present a 6-year-old boy who developed CT after CVC insertion in the right internal jugular vein, with its tip in the inferior vena cava. Initially, he was hospitalized to a tertiary hospital with presumptive diagnoses of pneumonia and left ankle cellulitis. Three days after CVC placement, he developed CT, manifesting as recurrent episodes of hypotension and bradycardia. Once a bedside echocardiography showed CT, pericardiocentesis was performed, resulting in successful resuscitation. Pericardiocentesis revealed a milk-appearing pericardial fluid, indicating chylopericardium. The boy also underwent debridement and joint irrigation of the left ankle, which turned out to be osteomyelitis. Although CVC tips in most reported CVC-related CTs have been commonly located in the right atrium, our case featured a tip located in the inferior vena cava. Additionally, chylopericardium was likely due to the extravasation of total parenteral nutrition fluid, rather than the usual causes, such as recent thoracic surgery. Understanding the mechanisms behind chylopericardium associated with CVCs and timely pericardiocentesis is crucial for improving the outcomes.

Keyword

Cardiac Tamponade; Central Venous Catheters; Pediatrics; Pericardial Effusion; Pericardiocentesis

Figure

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  Fig. 1. Serial chest radiographs. At transfer to the pediatric intensive care unit (day 4), it shows the tip of central venous catheter located in the inferior vena cava (arrowheads). An endotracheal (asterisks) and nasogastric tubes (arrows) are inserted (A). The tip position remains unchanged when sudden hypotension and bradycardia develop, before pericardiocentesis (day 7) (B), and after the pericardiocentesis (day 8) (C).

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  Fig. 2. After pericardiocentesis (day 7), a follow-up echocardiogram demonstrates a moderate amount of pericardial effusion. The fluid depths were 5.7 and 4.4 mm in the posterior of left ventricle on a parasternal long-axis view (A) and in the posterior of left ventricle on a parasternal short-axis view (B), respectively.

Reference

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