Review article: the diagnostic approach and current management of chylous ascites

Lizaola, Blanca; Bonder, Alan; Trivedi, Hirsh D.; Tapper, Elliot B.; Cárdenas, Andrés

doi:10.1111/apt.14284

Cited by 122 publications

(181 citation statements)

References 69 publications

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“…Chylous ascites, an uncommon entity, is characterized by presence of milky peritoneal fluid abundant in triglycerides, nutrients and immunoglobulins resulting from congenital or acquired abnormalities of abdominal lymphatics. Although various etiologies have been described that result in this clinical entity, v.i.z, malignancy, infection, abdominal surgery, trauma, cirrhosis among others, the condition is uncommon and chylous ascites accounts for a very small number of overall ascites cases and as per published literature the current incidence is 1 case per 20,000 admissions (1).…”

Section: Introductionmentioning

confidence: 99%

Underlying etiology determines the outcome in atraumatic chylous ascites

Mandavdhare

Sharma

Singh

et al. 2018

IRDR

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Chylous ascites is an uncommon entity and infectious etiology is the most common cause in developing countries. However, recently, whether there is any change in trend of etiologies in developing countries is not known. In this study, a retrospective analysis of the data of cases of atraumatic chylous ascites was conducted. Twelve patients of atraumatic chylous ascites with a mean age of 35 years were studied and 6 of them were males. The mean duration of symptoms was 9.6 months and the clinical presentation was abdominal distension (12 cases), pain abdomen (10 cases), loss of appetite and weight (9 cases), peripheral lymphadenopathy (4 cases) and fever (3 cases). Etiologies were tuberculosis (3 cases), malignancy (2 cases), radiotherapy related (2 cases), pancreatitis related (2 cases), lymphatic malformation (2 cases) and multifactorial (1 case). Eight improved with conservative measures, 2 were lost to follow up and 2 died. Our outcomes found infectious etiology still as the most common cause of atraumatic chylous ascites. Benign treatable causes could be managed successfully with conservative measures while malignant etiology had a poor prognosis. Underlying etiology determines the outcome in atraumatic chylous ascites.

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Section: Introductionmentioning

confidence: 99%

Underlying etiology determines the outcome in atraumatic chylous ascites

Mandavdhare

Sharma

Singh

et al. 2018

IRDR

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“…4 The disease affected this patient's vaginal wall, leading to chylous vaginal discharge; it affected her intestines, leading to hypoproteinemia and protein-losing enteropathy (Fig 2); and her retroperitoneal tissue was also affected by an asymptomatic macrocystic lymphatic malformation (Fig 1). Except for the chylous discharge, congenital chylorrhea (eg, GLA) can occur anywhere in the body and may be manifested as scrotal chylorrhea, 9,10 lymphedema of external genitalia, 11 chylothorax, 12,13 chylous ascites, 14,15 or chylopericardium. 16 T2-weighted MRI showed diffuse intestinal lesions (Fig 2), and the blood tests found hypoproteinemia, which indicated intestinal lymphangiectasia and protein-losing enteropathy in this patient.…”

Section: Discussionmentioning

confidence: 99%

Vaginal discharge caused by lymphatic malformation identified by lymphoscintigraphy combined with T2-weighted magnetic resonance imaging

Tang

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Prepubertal vaginal discharge is most commonly caused by vulvovaginitis and is rarely caused by lymphatic malformations, resulting in chylous vaginal discharge. The diagnosis of chylous vaginal discharge remains a challenge because of a knowledge gap. We describe a 12-year-old girl with intermittent vaginal discharge for 10 years. Although we found a high signal in the vagina on T2-weighted magnetic resonance imaging (MRI), the final diagnosis, vaginal lymphatic leakage, was established on lymphoscintigraphy. Lymphatic leakage in the vagina on lymphoscintigraphy was the key imaging feature of chylous vaginal discharge in this patient. Moreover, diffuse radioactivity was found in the abdomen and thorax on lymphoscintigraphy, which indicated the multiple cystic lymphatic malformations and intestinal lymphangiectasia combined with T2-weighted MRI. Thus, T2-weighted MRI could be used in combination with lymphoscintigraphy to simply identify chylous vaginal discharge. (J Vasc Surg Cases and Innovative Techniques 2020;6:1-5.)

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“…Total parenteral nutrition has been described as the method of choice for nutritional therapy as enteral nutrition promotes the formation of chyle. The administration of octreotide reduces intestinal fat absorption, concentration of triglycerides in the thoracic duct and in lymphatic vessel flow [16,31,32], although some reports does not agree with this concept [33].…”

Section: Discussionmentioning

confidence: 99%

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

Aranalde¹,

Lorenzin²,

Cánaves³

et al. 2019

AJIM

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The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.

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Review article: the diagnostic approach and current management of chylous ascites

Cited by 122 publications

References 69 publications

Underlying etiology determines the outcome in atraumatic chylous ascites

Underlying etiology determines the outcome in atraumatic chylous ascites

Vaginal discharge caused by lymphatic malformation identified by lymphoscintigraphy combined with T2-weighted magnetic resonance imaging

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

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