67

Effusions can show some surprises. We document the case of a fourteen-month-old male patient with short bowel syndrome, hospitalized in a cardiology unit, receiving chronic parenteral nutrition via a Broviac® catheter. The patient presented multiple thromboses following iterative catheter replacements. In parallel with superior vena cava plasty, a right intra-atrial Broviac® catheter was inserted in the absence of other peripheral venous accesses. This device has a cutaneous exit site to allow for infusion of a hyperosmolar lipid emulsion. Seven days later, a milky liquid was secreted from a pericardial/mediastinal Redon drain. A gel lipoprotein electrophoresis of the fluid suggested a preliminary diagnosis of chylopericardium. However, biochemical testing of certain analytes pointed to a parenteral nutrition-related pericardial effusion and a possible pseudo-chyloperitoneum caused by the shearing of a migrated Broviac® in the pericardium. The patient, on a fat-free diet, was admitted to the ICU to drain the effusion and reposition the catheter, with success. In the light of new data on the interference of parenteral lipid emulsions with lipoprotein gel electrophoresis, we attempt to determine whether the apparent presence of chylomicrons in the gel is a sign of a lesion of the lymphatic system, or instead the result of contamination by artificial chylomicron in the lipid emulsion, if not a sign of contaminated blood. In our article, we highlight several considerations for when it comes to identifying and confirming cases of pericardial effusion, including a chylopericardium and parenteral nutrition-related one, as well as points concerning the use of lipid emulsions for pediatric patients with short bowel syndrome.