Search

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., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Hoa et al.)

Background: Thoracic duct (TD) stenting is considered a treatment option for certain pathological conditions caused by TD obstruction, such as chyluria. Several studies have reported on the efficacy of TD stent treatment for both obstructive and leakage condition of TD, but few have evaluated the stent patency. This report aims to describe the patency of TD stent and the effectiveness of renal-lymphatic fistula embolization in the treatment of chyluria., Case Presentation: We report a case of chyluria treated by TD stent previously, stent was placed at the TD venous junction four months before the symptoms recurred. At the second intervention we found the stent was obstructed by debris. We recanalized the stent and successfully catheterised the microcatheter through the stent retrograde into the TD then into the renal-lymphatic fistula branch. After embolization of that abnormal branch, the recurrent chyluria was treated and no further episode of chyluria was occurred during 12 months follow up., Conclusion: Stent in the TD may be occluded by debris. Embolization of renal-lymphatic fistula might be the most important treatment for spontaneous chyluria., (© 2023. Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and Springer International Publishing AG.)

Chyle leak is a rare and serious condition caused by damaged lymphatic vessels. It can occur after retroperitoneal surgery involving extensive lymphadenectomy for kidney cancer. Besides lymphatic channel damage, the obstruction of the thoracic duct worsens the leakage. Managing patients with thoracic duct obstruction and postsurgical chyle leakage is challenging due to limited data on how to handle this condition. In this case report, a 28-year-old female patient underwent left nephrectomy for left kidney cancer. Three days after the surgery, milky fluid drained from the left renal fossa. Conservative treatment failed, and further examination through magnetic resonance lymphangiography revealed the absence of the thoracic duct and contrast extravasation at the left renal fossa. Lymphangiography confirmed distal thoracic duct obstruction. The patient's condition was successfully managed by using thoracic duct stenting. This report contributes to the understanding that thoracic duct obstruction can lead to lymphatic collateral circulation within the abdomen, thereby increasing the risk of postoperative chylous leak., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)