Case report of refractory pericardial effusion associated with lymphatic fistula due to surgical injury during sternotomy

RATIONALE A 35-year old Chinese female was admitted to hospital with refractory pericardial effusions 10 days post mitral valve replacement via median sternotomy. We performed an exploratory resternotomy and found lymphatic leakage on the surface of the diaphragm which was continuously emitting a light yellow fluid. PATIENT CONCERNS The patient complained of no obvious discomfort except for the concern of massive pericardial effusion drainage. DIAGNOSES Exploratory resternotomy and biochemical testing lead to a supradiaphragmatic lymphatic fistula being diagnosed as the cause of the refractory pericardial effusion. INTERVENTIONS The fistula was closed with a continuous suture and no other fistulas were found after a thorough exploration. OUTCOMES The patient was discharged home on postoperative day 5 and recovery was uneventful. LESSONS In this case a timely exploratory resternotomy proved effective in seeking the cause of and treating pericardial effusion following cardiac surgery.