Superior vena cava syndrome, pleural effusion, and pericardial tamponade are life-threatening complications of mediastinal masses. Although definitive therapy consists of treating tumor itself, drainage of effusions can reduce cardiorespiratory compromise until the tumor has regressed. Medium-chain triglycerides and parenteral alimentation can control chyle production in chylous effusions.1-4 We describe a child with a malignant mediastinal tumor in whom a fat-free diet abruptly stopped production of chylous pericardial fluid refractory to other forms of management.
Report of a Case.—A 12-year-old girl was referred to Children's Hospital of Philadelphia in April 1980 for evaluation of an anterior mediastinal mass. Two weeks before admission she began to have swelling in her face and neck, fever, cough, dyspnea, and inability to lie flat. She had lost 3 kg in the previous week.
She was a slightly obese girl in respiratory distress. Her temperature was 36.5 °C; heart rate, 132 beats per minute;