儿童原发性乳糜性心包积液1例报告并文献复习

Primary chylopericardium in children: a case report and literature review

目的探讨儿童原发性乳糜性心包积液的临床特点及诊治。方法回顾分析1例确诊儿童原发性乳糜性心包积液患儿的临床资料,并以"children primary chylopericardium"、"pediatric primary chylopericardium"、"儿童原发性乳糜性心包积液"为关键词,在万方数据知识服务平台、中国知网、PubMed数据库中检索,收集并分析已报道的国内外儿童原发性乳糜性心包积液病例。结果患儿,女,3岁11月龄,咳嗽、胸闷、胸痛、呼吸困难;心脏浊音界扩大,心音遥远,心律齐,未闻及心脏杂音。胸片示心影外形增大。彩色多普勒超声心动图示中大量心包积液。心包穿刺引流出乳糜样液体。经过对症支持治疗,患儿病情好转,但心包腔内仍有积液。随访1年余,心包积液量逐渐减少,患儿无特殊不适。结论原发性乳糜性心包积液在儿童中罕见,发生不明原因呼吸困难和心音低钝时需警惕,确诊需要行心包穿刺术。

Objective To explore the clinical characteristics,diagnosis and treatment of primary chylopericardium in children.Methods The clinical data of primary chylopericardium in a child were analyzed retrospectively.And the key words of "children primary chylopericardium","pediatric primary chylopericardium" were used to search in Wanfang database,CNKI and PubMed to collect and analyze the reported cases of primary chylopericardium in children at home and abroad.Results A girl,aged 3 years and 11 months,had cough,chest tightness,chest pain and dyspnea.The girl also had dilated cardiac dullness,distant heart sounds,regular cardiac rhythm,and no murmurs.Chest radiograph showed an enlarged heart shadow and color Doppler echocardiography indicated a large amount of pericardial effusion.Chylous fluid was drained by pericardiocentesis.After symptomatic support treatment,the child’s condition improved,but there was still fluid in the pericardial cavity.The amount of pericardial effusion decreased gradually during the follow-up of more than one year,and the child had no special discomfort.Conclusion Primary chylopericardium is rare in children.It is necessary to be alert of it when dyspnea and distant cardiac sound occur for unknown reasons,and pericardiocentesis is needed for diagnosis.