Idiopathic primary chylopericardium with associated chylothorax following coronary artery surgery - Successful conservative treatment

A 58-year-old Asian male underwent an uneventful triple coronary bypass that included a pedicled left internal mammary artery (LIMA) graft. On the third postoperative day, following resumption of full oral intake he developed a high output left-sided chylothorax. Initial therapy with a medium chain trigylceride diet and intercostal drainage showed no improvement. CT scan demonstrated a chylopericardium that was drained percutaneously. Complete resolution occurred 2 weeks later with adequate drainage and institution of total parenteral nutrition avoiding further surgery. We discuss the etiology and management of this rare complication following coronary surgery.