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American Journal of Roentgenology, Vol 102, 455-465, Copyright © 1968 by American Roentgen Ray Society

LYMPHOGRAPHY IN CHYLURIA

P. RUBEN KOEHLER M.D.1, TZE-CHUN CHIANG M.D.1, CHIN-TZER LIN M.D.1, KAI-CHYR CHEN M.D.1, and KUANG-YAO CHEN M.D.1

1 From the Department of Radiology, National Defense Medical Center, Taipei, Taiwan, Republic of China and the Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri

Chyluria is invariably associated with lymphatic abnormalities. As part of our study, 15 patients who manifested chyluria were examined by means of lymphography.

In Table 1 are summarized the roentgenographic changes found on the lymphograms of these 15 patients and 17 others which were reported in the English literature. There was a moderate to marked increase in number, size and diameter of pelvic and retroperitoneal lymph vessels. The vessels were tortuous. When chyluria was associated with elephantiasis, similar appearing vessels could be found in the swollen extremities and/or genitalia. Many abnormal communications between the retroperitoneal and renal lymph vessels exist. Intrarenally, these vessels follow the collecting system and not infrequently a fine halo of lymph vessels can be seen surrounding the minor calyces. An important, fairly consistent finding was the marked decrease in the number of visualized lymph nodes in the pelvis and retroperitoneum. These lymph nodes fail to visualize because of fibrosis. The fibrotic lymph nodes contribute to the formation of lymph stasis and obstruction.

The thoracic duct was usually visualized. In our series the duct was normal in 13 out of 15 cases. This finding is also confirmed by others.

The roentgenographic demonstration of a normal thoracic duct in patients with chyluria, and experimental studies of lymphatic dynamics following thoracic duct ligation, cast serious doubt on the currently prevailing theory on the pathogenesis of chyluria, in which lymphatic backflow caused by an obstructed thoracic duct is believed to be the cause for the appearance of the lymph in the urine.

The pathogenesis of chyluria in light of new evidence obtained by in vivo observation of lymphatic dynamics in chyluria is discussed. The etiology, epidemiology, Clinical manifestations and therapy are briefly considered.


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Copyright © 1968 by the American Roentgen Ray Society.