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. 2024 May 28:17:2489-2495.
doi: 10.2147/IJGM.S459768. eCollection 2024.

Central Lymphatic Imaging in Adults with Spontaneous Chyluria

Tran Quoc Hoa  1 , Nguyen Ngoc Cuong  2 , Nguyen Cong Hoan  3 , Nguyen Quang Trung  2 , Thieu Thi Tra My  4 , Nguyen Ngoc Anh  5 , Hoang Long  1
Affiliations

Central Lymphatic Imaging in Adults with Spontaneous Chyluria

Tran Quoc Hoa et al. Int J Gen Med. .

Abstract

Purpose: Chyluria is a rare condition primarily prevalent in developing countries in tropical regions. In chyluria, there exists the communication between lymphatic vessels and the urinary tract, but the specific mechanism of this communication remains undocumented. The objective of this study was to assess the morphology of the main lymphatic vessels including the uro-lymphatic fistula, the thoracic duct using Magnetic Resonance Lymphangiography (MRL) and Intranodal Lymphangiography (IL).

Materials and methods: A retrospective study spanning five years, from January 2020 to January 2024, included 43 patients diagnosed with chyluria through cystoscopy and quantitative urine testing for triglycerides. These patients underwent MRL and then IL for uro-lymphatic fistula embolization.

Results: The study involved 43 patients with an average age of 66.1 ± 19.5 years, with a male-to-female ratio of 1:2. Uro-lymphatic fistula occurred predominantly in the left kidney (72.1%), followed by the right kidney (20.9%), and both sides (7%). MRL imaging showed the thoracic duct in 100% of cases but visualized only 84.5% of the uro-lymphatic fistulas. In contrast, IL imaging showed the thoracic duct in 51.5% of patients but visualized uro-lymphatic fistulas in 100% of cases. In the procedure of IL, the average visualization time of the thoracic duct was 45 minutes, with a range of 35 to 69 minutes.

Conclusion: MRL and IL complement each other in diagnosing the main lymphatic vessels in chyluria patients. The observed circulatory stasis in the thoracic duct supports the hypothesis that it contributes to increased pressure in the thoracic duct and the formation uro-lymphatic fistula as collateral circulations.

Keywords: MR lymphangiography; chyluria; intranodal lymphangiography; uro-lymphatic fistula.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Dilatation TD and uro-lymphatic fistula seen on MRL. MR lymphangiography reformatted at coronal view of a 64-year-old female patient. (A) TD was tortouses and dilated at the distal part (arrow) where there was obstruction at the TD-veinous junction. (B) Dilated lymphatic vessels at the lumbar level were afferent into the left kidney (arrows).
Figure 2
Figure 2
Comparison of MRL and IL in depicting the TD and urolymphatic fistula. A 62-year-old male with chyluria for 3 months. MRI (A) and IL (B) showed the dilated lymphatic vessel at the lumbar level and uro-lymphatic fistula at both kidneys (straight arrow on the right kidney and curved arrow on the left kidney).
Figure 3
Figure 3
Intranodal lymphangiography of a 54-year-old female patient with chyluria for 2 months. (A) Obstruction at the TD-venous junction (long arrow), leading to collateral lymphatic circulation at the neck (short arrows). (B) Dilated lymphatic vessel at the lumbar level and a uro-lymphatic fistula observed in the left kidney (arrows).
See this image and copyright information in PMC

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