Pulmonary hypertension as a rare cause of postoperative chylothorax

Chylothorax in adult occurs most commonly in the wake of cardiac and thoracic procedures. Injuries to the common thoracic duct in the thorax or its branches in the mediastinum, injuries to the thymus tissues, dissection of the superior vena cava or ascending aorta, dissection of the aortic arch, disruption of the accessory lymphatics in the left or right thorax, and increased pressure in the systemic vein exceeding that of the thoracic duct [usually in the superior vena cava thrombosis, Glenn Shunt, and hemi-Fontan] have been proposed as the possible causes of chylothorax after surgery for congenital heart disease. However, pulmonary hypertension is an exceedingly rare cause of chylothorax in adults. We present a case of chylothorax after atrial septal defect surgery in a 30-year-old female patient with pulmonary hypertension. The postoperative period was complicated by chylothorax, which was confirmed by the high lipid content of chylous effusion. The patient was treated conservatively with diet therapy, and the effusion was abolished completely after two weeks. No recurrence of chylothorax was detected at 3 months' follow-up

Right atrial angiosarcoma with severe biventricular dysfunction and massive pericardial effusion

This paper presents the case of a 35 year-old woman with symptoms of heart failure from the last month. A physical examination at admission showed paleness, dyspnea, peripheral edema and fatigue. In a two-dimensional echocardiography and transesophageal echocardiography, normal thickness but severe left and right ventricular dysfunction with severe pericardial effusion and thickened pericardium were found. In the enlarged right atrium, an oval-shaped structure was found with features of continuity with lateral right atrial wall and also a bulging of the structure through the orifice of the tricuspid valve to the right ventricle. In the echocardiography, we did not saw any blocking of the tricuspid valve or the inflow from inferior vena cava [IVC] or superior vena cava [SVC] or coronary sinus. On the basis of the echocardiography examination and clinical presentation, tentative diagnosis of the right atrium myxoma was made. A coronary angiography revealed normal coronary arteries and no feeding of tumor by branch of right coronary artery [RCA]. Surgical removal of the tumor was performed without complication. The histopathological examination confirmed the diagnosis of angiosarcoma. In the follow-up echocardiography carried out after three months, severe left ventricular [LV] and right ventricular [RV] dysfunction continued and was demonstrated. Magnetic resonance imaging revealed no lymphadenopathy or re-growth of the tumor in the mediastinum or pericardium