Chylopericardium to post-traumatic chylopericardium, the conserva- tive treatment of idiopathic chylopericardium is rarely successful. Surgical treatment is usually required, however, it should be noted that only one case treated conservatively has been reported.12 Nevertheless, initially, a patient should be treated conservatively by pericardial drain placement and the institution of a medium chain triglyceride diet or total parenteral nutrition.10 If this approach fails, then surgical ligation of the thoracic duct just above the diaphragm combined with window formation or pericardiectomy to ensure adequate drainage has been reported to be definitive treatment.8-11,13-15 Pericardial drainage with pericardiocentesis or tube thoracostomy with or without dietary management was also found effective, but in many cases reaccumulation occurred.9 Pericardio-peritoneal shunt placement has been advocated by Chan et al.22 as a simple and effective alternative to prolonged pericardial drainage or thoracotomy. Although most authors reported surgery as the definitive method of treatment, Lopez-Castilla et al.12 reported the successful treatment of a 2-month-old boy by low fat total parenteral nutrition. In our patient, external drainage of the pericardial sac via the pericardiostomy, concomitant with dietary sup- port with medium chain triglyceride and low fat meals, resulted in the complete resolution of pericardial effusion. Six months later, the patient was asymptomatic and the chest X-ray showed a normal cardiac size. This success in our case reasserts the importance of conservative treatment for the management of primary idiopathic chyl- opericardium. If symptoms develop or massive pericardial effusion recurs, thoracic duct ligation will be considered in this patient. In summary, our case supports that pericar- diostomy combined with total parenteral nutri- tion and a low fat dietary support is a treatment modality for primary idiopathic chylopericar- dium REFERENCES 1. Crosby IK, Crouch J, Reed WA. Chylopericardium and chylothorax. J Thorac Cardiovasc Surg 1973;65:935-9. 2. Barton JC, Durant JR. Isolated chylopericardium associated with lymphoma. South Med J 1980;73:1551. 3. Smedts F, Kubat K, Chande H. Chylopericardium and chylothorax, resulting from a catheter to the left sub- clavian vein: an autopsy report. Klin Wochenschr 1989; 67:1214-7. 4. Lorell BH, Braunwald E. Pericardial disease. In: Braunwald E, editor. Heart disease. A textbook of cardiovascular medicine. Philadelphia: W.B. Saunders; 1992. p.1505. 5. DeMeester TR, Lafontaine E. The pleura. In: Sabiston DCJ, Spencer FC, editors. Gibbon's Surgery of the chest. Philadelphia: W.B. Saunders; 1983. p.369-72. 6. Delaney A, Daicoff GR, Hess PJ, Victorica B. Chylo- pericardium with cardiac tamponade after cardio- vascular surgery in two patients. Chest 1976;69:381-3. 7. Bar-el Y, Smolinsky A, Yellin A. Chylopericardium as a complication of mitral valve replacement. Thorax 1989;44:74-5. 8. Groves LK, Effler DB. Primary chylopericardium. N Engl J Med 1954;250:520-3. 9. Yoon YS, Shim WH, Chung TS, Lee YS. Primary idiopathic chylopericardium: Report of a case and review of the literature. Yonsei Med J 1993;34:98-108. 10. Ossiani MH, McCauley RGK, Patel HT. Primary idiopathic chylopericardium. Pediatr Radiol 2003;33: 357-9. 11. Svedjeholm R, Jansson K, Olin C. Primary idiopathic chylopericardium- a case report and review of the literature. Eur J Cardio-thorac Surg 1997;11:387-90. 12. Lopez-Castilla JD, Soult JA, Falcon JM, Munoz M, Santos J, Gavilan JL, et al. Primary idiopathic chylo- pericardium in a 2 month old successfully treated without surgery. J Pediatr Surg 2000;35:646-8. 13. Akashi H, Tayama K, Ishihara K, Tanaka A, Fujino T, Okazaki T, et al. Isolated primary chylopericardium. Jpn Circ J 1999;63:59-60. 14. Akamatsu H, Amano J, Sakamoto T, Suzuki A. Pri- mary chylopericardium. Ann Thorac Surg 1994;58: 262-6. 15. Yuksel M, Yildizeli B, Zonuzi F, Batirel HF. Isolated primary chylopericardium. Eur J Cardio-thorac Surg 1997;12:319-21. 16. Hudspeth AS, Miller HS. Isolated (primary) chyloperi- cardium. J Thorac Cardiovasc Surg 1966;51:528-31. 17. de Menezes IC, Araujo eSG, Damiao A, Telo M, Martins FM, Macedo MM. Lymphangioma of the mediastinum as a cause of chylopericardium. Acta Med Port 1990;3:119-21. 18. Goldstein MR, Benchimol A, Cornell W, Long DR. Chylopericardium with multiple lymphangioma of bone. N Engl J Med 1969;280:1034-7. 19. Bhatti MAK, Ferrante JW, Gielchinsky I, Norman JC. Pleuropulmonary and skeletal lymphangiomatosis with chylothorax and chylopericardium. J Thorac Surg 1985; 40:398-401. 20. Tucker SM. Bilateral chylothorax with multiple osteo- lytic lesion?: generalized abnormality of lymphatic system. Proc Roy Soc Med 1967;60:17-9. Yonsei Med J Vol. 46, No. 3, 2005