International Journal of General Medicine (May 2024)

Central Lymphatic Imaging in Adults with Spontaneous Chyluria

  • Hoa TQ,
  • Cuong NN,
  • Hoan NC,
  • Trung NQ,
  • Tra My TT,
  • Anh NN,
  • Long H

Journal volume & issue
Vol. Volume 17
pp. 2489 – 2495

Abstract

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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 Long1 1Surgery Urology, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam; 2Radiology Center Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam; 3Outpatient department, Hanoi medical university hospital, Hanoi medical university, Hanoi, Vietnam; 4Radiology Department, Vinmec Times city Interational Hospital, Hanoi, Vietnam; 5Anatomy Department, Hanoi Medical University, Hanoi, VietnamCorrespondence: Nguyen Ngoc Cuong, Radiology center, Hanoi medical university hospital, No. 1, Ton That Tung Street, Dong Da District, Hanoi, Viet Nam, Tel +84965131314, Email [email protected]: 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: chyluria, MR lymphangiography, intranodal lymphangiography, uro-lymphatic fistula

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