Unipedal Diagnostic Lymphangiography Followed by Sequential CT Examinations in Patients With Idiopathic Chyluria: A Retrospective Study

Chyluria is secondary to the presence of chyle in the urine. The classical appearance on inspection is of milky white urine, which is caused by a fistulous communication between the lymphatic system and the urinary tract. Worldwide, it is most commonly associated with the parasite Wuchereria bancrofti, which is prevalent in Asia, most extensively in India but also China and Taiwan. However, in the United Kingdom, Europe and North America, where the condition is rare, non-parasitic aetiologies predominate. Chyluria is occasionally associated with other urinary tract symptoms including infection, loin pain and haematuria. It may also cause hypoproteinaemia, weight loss and cachexia. Management is based on identifying the aetiology and depends on the severity of the chyluria and presence of associated symptoms. Given its predominate symptom being urinary, cases in the West can fall under the care of the urologist. The aim of this article is to provide an overview and summary of the aetiology, assessment and management of chyluria based on the most up-to-date evidence available. This was achieved through a non-systematic review of world literature.

show abstract

“…They determined this allowed for enhanced identification of lymphatic anomalies and the distribution of collateral lymphatic vessels. 30 …”

Section: Managementmentioning

confidence: 99%

Chyluria: what does the clinician need to know?

Stainer

Juliebø‐Jones

Juliebø

et al. 2020

Therapeutic Advances in Urology

View full text Add to dashboard Cite

show abstract

“…Interestingly, the association between retrograde pyelography and MRI seems to be effective in the evaluation of chyluria due to a detailed intra-abdominal evaluation [14] . CT performed after diagnostic lymphangiography has been used as a complementary tool for diagnostic lymphangiography [15] . A CT scan identifies the presence of a fat-fluid level in the urinary bladder.…”

Section: Discussionmentioning

confidence: 99%

Trans-urethral resection of bladder tumor (TURBT) and radiofrequency ablation of renal tumor: Rare etiologies of chyluria

Assaker

Hasbani

Vargas

et al. 2020

Radiology Case Reports

View full text Add to dashboard Cite

Chyluria is a rare entity which is caused by abnormal communication between the lymphatic system and the urinary tract, which allows the passage of chyle into the urine. Whenever symptomatic, chyluria presents with lower urinary tract symptoms such as dysuria and hematuria. Multiple imaging modalities can aid in diagnosis such as lymphoscintigraphy, retrograde pyelography, CT scan of the abdomen and pelvis, and magnetic resonance imaging. Numerous etiologies are associated with chyluria among which are surgical interventions. Partial and radical nephrectomy have been reported in a number of symptomatic and asymptomatic cases, while radiofrequency ablation of renal tumors has been very rarely reported. Herein, we report 2 cases of chyluria; one caused by trans-urethral resection of a bladder tumor and another by radiofrequency ablation of a renal oncocytoma. Fat-fluid level in the urinary bladder was seen on both precontrast and postcontrast images of CT scan of the abdomen and pelvis. Cystoscopy demonstrated no evidence of any abnormality of the urinary bladder.

show abstract

“…As with XRL, CT can be acquired in the lymphangiographic (immediately after XRL) or nodal phase (1 day after XRL) depending on diagnostic aims 45,79 . Instead of a fixed timing of post-XRL CTL, the author recommends acquisition of CT images in the lymphangiographic phase immediately after opacification of the relevant anatomical structures on fluoroscopy to get an optimal anatomical depiction of the lymphatic vascular system or to perform delayed post-XRL CTL 24 hours after XRL to search for delayed contrast extravasation 80 …”

Section: Transnodal X-ray Lymphangiographymentioning

confidence: 99%

“…45,79 Instead of a fixed timing of post-XRL CTL, the author recommends acquisition of CT images in the lymphangiographic phase immediately after opacification of the relevant anatomical structures on fluoroscopy to get an optimal anatomical depiction of the lymphatic vascular system or to perform delayed post-XRL CTL 24 hours after XRL to search for delayed contrast extravasation. 80 More recently, initial small case series and case reports have described CTL with transnodal injection of water-soluble x-ray contrast agent as a technically simpler alternative to DC-MRL. 35,[81][82][83] Dynamic contrast-enhanced MRL poses several logistical challenges, including necessary nodal needle placement outside of the scanner room with a theoretic risk of needle dislodgement during transfer back into the MR scanner.…”

Section: Ct Lymphangiographymentioning

confidence: 99%

Back to the Future II—A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions

Pieper

2023

Invest Radiol

View full text Add to dashboard Cite

Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.

show abstract

Unipedal Diagnostic Lymphangiography Followed by Sequential CT Examinations in Patients With Idiopathic Chyluria: A Retrospective Study

Cited by 14 publications

References 18 publications

Chyluria: what does the clinician need to know?

Chyluria: what does the clinician need to know?

Trans-urethral resection of bladder tumor (TURBT) and radiofrequency ablation of renal tumor: Rare etiologies of chyluria

Back to the Future II—A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions

Contact Info

Product

Resources

About