Lymphangiography in a Patient with Chylous Ascites

Although radiologic visualization of the lymphatic system was reported thirty-one years ago (2), it was not until 1952 that a practical method was described by Kinmonth et at. (9). Subsequently, numerous excellent works have attested to the value of lymphangiography (1, 3–5, 12–14). Recently we had occasion to investigate a patient exhibiting chylous ascites secondary to lymphosarcoma. We believe this case is the first to be published in which lymphangiography was utilized in chylous ascites. Case Report A 43-year-old Caucasian male was first admitted to the Coral Gables Veterans Administration Hospital on March 28, 1961, because of progressive swelling of the abdomen of two weeks duration, associated with cramping abdominal pain. One year prior to admission the patient had noticed a tendency to tire easily, anorexia, and a progressive 15-pound weight loss. His past medical history was unremarkable. Physical Examination: On physical examination the patient appeared well nourished and well developed, with normal vital signs. Multiple large (2 × 3 cm.) non-tender axillary nodes were palpable. There were increased dullness to percussion and decreased breath sounds to auscultation at both lung bases. The abdomen was markedly distended and tense, with moderate diffuse tenderness elicited upon palpation. Bowel sounds were present but hypoactive. Shifting dullness and a palpable fluid wave were demonstrated. On admission, the hemoglobin was 13.0 gm. per cent; hematocrit 40 per cent; the white blood count was 7,940 per cubic millimeter with a normal differential count. Urine examination was normal, as were the blood urea nitrogen, fasting blood sugar, serum uric acid, alkaline phosphatase, glutamic oxalacetic transaminase, and leucine aminopeptidase. The serum protein electrophoresis revealed a total protein of 6.81 gm. per cent and a non-specific increase in alpha-2-globulins. The serum albumin was 3.90 gm. per cent. The direct and indirect Coombs's tests were negative and platelets were normal. The prothrombin time was normal, as were the serum electrolytes. Radiologic Data: A chest roentgenogram (Fig. 3) revealed elevation of the diaphragm with left pleural effusion. A radiograph of the abdomen showed several distended loops of small bowel in the left upper quadrant, with evidence of ascites. A barium-enema examination failed to demonstrate any intrinsic colonic lesion. A small-bowel study revealed slight segmentation of the opaque column with a normal transit time. An esophagram, upper gastrointestinal series, and intravenous pyelogram were normal. Two and one-half weeks after admission lymphangiography was performed. The technic employed has been reported in the literature (8). The right and left inguinal nodes were normal in size, shape, and architecture.