Non-tropical chyluria: CT diagnosis

Abstract

Chyluria is commonly associated with filariasis, which is prevalent among the population of tropical and subtropical regions. Chyluria is seldom encountered in the United States and other western countries, but may occur if the flow of chyle into the thoracic duct is blocked due to inflammatory, neoplastic, or various other etiologies. We report 10 adult patients, in whom the detection of fat-urine level in their bladder on abdominal CT provided the initial diagnostic clue to the presence of chyluria. This series included 7 men and 3 women, who ranged in age from 25 to 91 years (mean: 62 years). The associated lesions included renal angiomyolipomas (2), lymphangiomas of the kidney and bladder (1), metastatic testicular cancer (1), postoperative status following partial nephrectomy for renal cell carcinoma (4), left radical nephrectomy (1), and segmental cystectomy for carcinomas (1). The clinical and radiological features of this entity are presented along with a brief review of the pertinent literature.

Chyluria after partial nephrectomy: A rare but considerable complication

“…Contrast material within the perinephric collection space and fat in the bladder on CT after partial nephrectomy suggest the presence of chyluria. [3][4][5] Interestingly, RP can show a backward flow of contrast medium from the renal calyx to the retroperitoneal lymphatics, and confirmed communication between the renal collecting system and lymphatic vessels, including the renal, peripelvic and retroperitoneal lymphatics, as in the present case. In a study by Dalela et al, RP with adequate pressure showed pyelolymphatic fistulae in 73% of patients.…”

“…2 However, chyluria after nephrectomy is very rare, and just four reports have been published. [2][3][4][5] We herein summarized the characteristics of 11 patients with chyluria after nephrectomy ( Table 1). Two underwent radical nephrectomy and nine underwent partial nephrectomy.…”

Robotic surgery for treatment of chyluria

“…Only a handful of non-parasitic causes have been reported. These include obstruction of the thoracic duct or lymphatics, congenital etiologies, lymphangioma of the urinary tract, megalymphatics, urethral/vesical fistulae, stenosis of the thoracic duct, retroperitoneal lymphangiectasia, traumatic lymphangiourinary fistulae, pregnancy, diabetes, abscess, and nephrotic syndrome [8]. It can also result as a complication of radiofrequency ablation of renal cell carcinoma [9].…”

Milky White Urine After Relief of Urinary Retention

“…Ultrasonography may show clots in the bladder with echolucent areas within secondary to the chylomicrons (1). A computed tomography scan may show fat densities within the bladder/urine and possibly the presence of dilated lymphatics (9,10).…”