Idiopathic chylopericardium temporally associated with short-term high-fat dietary excess in a young man: a case report

Idiopathic chylopericardium is a rare and potentially serious condition typically managed conservatively, though surgical intervention is often required. This case report describes a 22-year-old man with no significant past medical history who presented with acute chest pain and dyspnea following a one-week period of excessive high-fat dietary intake. Physical examination revealed a characteristic forward-leaning posture. Laboratory evaluation demonstrated hypertriglyceridemia, while imaging confirmed moderate pericardial effusion without tamponade or constriction. Pericardiocentesis yielded 350 mL of chylous fluid, and subsequent lymphoscintigraphy suggested cessation of radiotracer transit at the supradiaphragmatic level. Comprehensive serologic testing ruled out infectious, autoimmune, and neoplastic etiologies. Following a presumptive diagnosis of idiopathic chylopericardium, the patient was successfully treated with a fat-restricted diet and octreotide, leading to complete symptom resolution and no recurrence at 2-month follow-up. This case highlights a temporal association between an extreme short-term high-fat dietary intake and the subsequent development of idiopathic chylopericardium. However, causality cannot be established based on a single case, and the current evidence supports only an association rather than a causal relationship, and supports the efficacy of conservative treatment in selected patients without hemodynamic compromise.