Chyluria is defined by the presence of chyle in urine, and is caused by a communication between the lymphatic and urinary system. Commonly, it is characterised by the excretion of milky white urine, which is present in up to 70% of chyluria cases. The prevalent cause for chyluria in Asia is filariasis with Wuchereria bancrofti. Non-parasitic chyluria is more common in western countries and is usually subsequent to traumatic factors, infections, or tumours. The occurrence of non-parasitic chyluria in the absence of trauma, iatrogenic or other, is exceedingly rare. The lymphatic system is rather challenging to visualize. Herein, we present a case of non-parasitic chyluria and our approach of combining different complementing imaging modalities, such as contrast-enhanced ultrasound (CEUS) retrograde pyelography and magnetic resonance (MR) lymphography.

Wegener’s granulomatosis, now more commonly referred to as granulomatosis with polyangiitis (GPA), is a rare, idiopathic, systemic inflammatory disease, most commonly involving the respiratory tract, kidneys, and sinonasal region. The condition affects small and medium-sized blood vessels, such as arteries, arterioles, venules, and capillaries. Some cases of the disease presenting as retroperitoneal fibrosis and/or affecting the aorta have been reported. Although advances in the treatment of GPA have contributed to a decline in mortality, early diagnosis is still of vital importance due to the possible complications of the disease. Here, we present the case of a 69-year-old man with acute-onset abdominal pain. Ultrasound of the abdomen showed left-sided hydronephrosis. Computed tomography detected cavitating pulmonary lesions and peri-iliac alterations caused by retroperitoneal fibrosis with involvement of the crossing ureter. Laboratory results revealed high antineutrophil cytoplasmic antibody levels and high inflammatory markers. A lung biopsy performed via bronchoscopy revealed necrotizing granulomas and solidified the diagnosis of GPA both in the lung and the peri-iliac region. Treatment with immunosuppressive agents and glucocorticoids was initiated. A follow-up after two months showed regression of the pulmonary lesions and partial resolution of the hydronephrosis as well as reduced inflammatory markers in the blood tests.