Unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography

Dingyi Liu,Jian Wang,Wenmin Li,Mingwei Wang,Wenlong Zhou,Qi Tang,Weimu Xia,Jiashun Yu,Yanfeng Zhou,Haidong Wang,Yuan Shao,Sang Hu,Boke Liu

doi:10.1186/s12894-018-0323-x

Abstract

BackgroundTo identify the value of unilateral pedal lymphangiography (LPG) plus computed tomography angiography (CTA) in accurate depiction of persistent idiopathic chyluria undetectable by ordinary contrast CT.MethodsEighteen patients 44–63 years of age with persistent idiopathic chyluria who failed conservative management were included. Ordinary CT had not revealed a chyle leak. Cystoscopy, unilateral LPG, and post-LPG CT angiography (CTA) were sequentially performed. Ligation and stripping of the perirenal lymphatics were subsequently performed guided by lymphangiography and CTA.ResultsLPG and post-LPG CTA detected 17 unilateral and one bilateral chyle leaks in the 18 patients, with clear images of the communication of lymphatic vessels and the renal collecting or vascular system. The success rate was significantly better than cystoscopy (100% vs 50.0%, P = 0.005) or LPG alone (100% vs. 72.2%, P = 0.016). Chyluria resolved after surgery in all patients; no relapses were found.ConclusionsLPG plus post-LPG CTA accurately characterized perirenal lymphangiectasia that was not demonstrated by routine contrast-enhanced CT or not suitable for magnetic resonance imaging. Despite of its invasiveness, this method is a good diagnostic alternative to LPG in patients with persistent chyluria requiring surgery.

Highlights

To identify the value of unilateral pedal lymphangiography (LPG) plus computed tomography angiography (CTA) in accurate depiction of persistent idiopathic chyluria undetectable by ordinary contrast CT
The aim of this study was to evaluate the value of unilateral LPG with post-LPG CT angiography (CTA) in chyluria patients who failed to conservative management with chyle leaks undetectable by ordinary contrast CT
LPG plus CTA was more successful than cystoscopy in locating the side of chyle leaks (100% vs. 50.0%, P = 0.005, Table 1)

Summary

Introduction

To identify the value of unilateral pedal lymphangiography (LPG) plus computed tomography angiography (CTA) in accurate depiction of persistent idiopathic chyluria undetectable by ordinary contrast CT. Methods: Eighteen patients 44–63 years of age with persistent idiopathic chyluria who failed conservative management were included. Ordinary CT had not revealed a chyle leak. Cystoscopy, unilateral LPG, and post-LPG CT angiography (CTA) were sequentially performed. Ligation and stripping of the perirenal lymphatics were subsequently performed guided by lymphangiography and CTA. The etiologies include thoracic duct stenosis, tuberculosis, cancer, trauma, pregnancy, filariasis, Liu et al BMC Urology (2018) 18:9 evaluation of the lymphatic system before treatment can be started. The aim of this study was to evaluate the value of unilateral LPG with post-LPG CT angiography (CTA) in chyluria patients who failed to conservative management with chyle leaks undetectable by ordinary contrast CT

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