Unilateral pedal lymphography in patients with filarial chyluria

Abstract

Objective To evaluate the usefulness of unilateral pedal lymphography in patients with ®larial chyluria. Patients and methods Of 114 patients with ®larial chyluria, all underwent lymphography (unilateral pedal in 106) and 55 underwent selective ureteric sampling for chyle. Results Unilateral pedal lymphography in the 106 patients detected lymphaticorenal ®stulae (LRF) in 104 (98%). Lymphatic crossover was seen in all 106 patients, from the second sacral segment to the ®rst lumbar segment. The most frequent crossover site was at the L5 level (87%). There was complete correlation between the side of LRF and the side of chyluria as assessed by selective ureteric sampling. Conclusion Unilateral pedal lymphography can detect LRF via lymphatic crossover even when it is on the opposite side from that injected with contrast agent. The advantages of unilateral lymphography over bilateral procedures are that it is easy to identify crossover channels, and the discomfort for the patient is reduced because there are fewer incisions and it is quicker. Unilateral lymphography is recommended as the initial method when lymphography is indicated in ®larial chyluria.

Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

“…Fistulas can often be identified by way of crossover channels that divert lymphatic flow from the contralateral lymphatics toward the fistula [10]. Koga et al reported lymphatic vessels crossing from the injected to the uninjected side occurred in all 106 patients with chyluria.…”

“…The direction of flow in the lymphatic channels, being a closed circulation system with a positive pressure, will converge to the point where the integrity of the channels has been breached. So unilateral LAG can detect chyle leakage even when it is on the side opposite that where contrast is injected [10]. The advantages of unilateral over bilateral LAG are that it is easy to identify crossover channels, and there is less discomfort for the patient because of fewer incisions and quicker procedure [10].…”

“…However, LAG combined with post-LAG CT imaging is superior in depicting and precisely localizing chylous abnormalities, while LAG has also been shown to be therapeutic in some instances [4-8]. Although bipedal LAG is recommended to demonstrate the anatomy of the thoracic duct and to indicate the cause of chylothorax [9], the diagnostic capabilities of unilateral pedal or monopedal LAG has also been demonstrated in the literature [10]. …”

The Advantages of Unilateral Pedal Lymphography in the Diagnosis of Chyluria

“…The main complications of PLG are fever, pain, nausea, vomiting, cough, hemoptysis, wound infection and embolism of lung, renal or brain vessels [1,2,8]. Complications such as fever, nausea and vomiting are related to the kind of contrast agent.…”

“…About 80% of patients with mild to moderate chyluria can be cured by conservative management such as low-fat/high-protein diet or renal pelvic instillation sclerotherapy with silver nitrate, povidone iodine, dextrose, etc. However, the 2-year recurrence rate is 22% [2]. For patients with severe chyluria or refractory disease, surgical intervention is recommended to disconnect the fistulous communication between the pelvicalyceal and the lymphatic system [3].…”