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Review
.2023 Jul 5;14(1):119.
doi: 10.1186/s13244-023-01461-2.

Chyluria: non-enhanced MR lymphography

Affiliations
Review

Chyluria: non-enhanced MR lymphography

Alexandre Sabbah et al. Insights Imaging..

Abstract

Chyluria is an uncommon medical condition resulting from an abnormal communication between the abdominal lymphatic system and the urinary tract, which results in the presence of chyle in the urine, making it appear milky white. Proper diagnosis is demonstrated by the concentration of urinary lipids. Worldwide, chyluria is most commonly associated with the parasite Wuchereria bancrofti. However, in Europe and North America, where the condition is rare, non-parasitic etiologies predominate. Identifying the cause and location of the uro-lymphatic communication is essential in guiding therapeutic management, but imaging the lymphatic channels remains a challenge. Magnetic resonance (MR) lymphography, a non-invasive free-breathing 3D high-resolution fast-recovery fast spin-echo sequence similar to that used for 3D MR cholangiopancreatography, may demonstrate the cause and location of an abnormal communication between the lymphatic system and urinary tract. In parasitic causes of chyluria, dilated lymphatics vessels communicating with the lymphatic system are demonstrated. In non-parasitic causes of chyluria channel type lymphatic malformations are the most common. Markedly dilated and dysplastic lymphatic vessels communicating with the urinary tract are demonstrated. In addition, other cystic or channel type lymphatic malformations such as thoracic, soft tissue or bone abnormalities may be observed. This review describes the abdominal lymphatic diseases leading to chyluria and presents the technique and images obtained with non-enhanced MR lymphography to enable radiologists in identifying and classifying uro-lymphatic fistulae.Critical relevance statement: Non-enhanced MR lymphography enables the identification and categorization of uro-lymphatic fistulae.

Keywords: Chyluria; Filariasis; Lymphatics; MR imaging; MR lymphography.

© 2023. The Author(s).

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Lymphatic anatomy (K: kidney, B: bladder)
Fig. 2
Fig. 2
38-year-old female patient with chyluria, chylothorax, and Gorham-Stout disease. Axial T2-weighted MR image (a) demonstrated dilated and enlarged lymphatic vessels in contact with the right kidney (arrow). Coronal MR lymphography with MIP reconstruction (b) demonstrated channel type lymphatic malformation (arrows) in contact with the right kidney (K). Mixed channel and cystic lymphatic malformation (arrowheads) replaced the thoracic duct. At the thoracic level, coronal MR lymphography with MIP reconstructionc demonstrated multiple dilated intercostal lymphatic vessels (arrows) with several cystic lymphatic malformations (arrowheads). Coronal T2-weighted MR image (d) demonstrated vertebral fractures, with a hyperintense signal within three vertebrae related to progressive osteolysis caused by Gorham-Stout disease (arrowheads). A cystic lymphatic malformation in contact with the vertebra was also demonstrated (arrow)
Fig. 3
Fig. 3
37-year-old male patient with chyluria. Coronal T2-weighted MR imagea demonstrated abnormal lymphatic vessels (arrow) in touch with the left renal pelvis, which was better seen by (b) coronal MR lymphography with MIP reconstruction. Dilated lymphatic vessels close to the left ureter (short arrows) were also demonstrated
Fig. 4
Fig. 4
83-year-old female patient with chyluria secondary to filariasis. Axial T2-weighted MR imagea demonstrated dilated and enlarged lymphatic vessels prevailing on the right side in contact with the right and left kidneys (arrows). The dilated lymphatic vessels (arrows) were better highlighted on MR lymphography with MIP reconstruction in the axial (b) and coronal (c) planes.R right kidney,L left kidney
Fig. 5
Fig. 5
35-year-old male patient with chyluria. Axial T2-weighted MR imagea demonstrated dilatation of the retroperitoneal lymphatic vessels prevailing on the right side (arrows) and in touch with the right ureter (arrowhead). Coronal MR lymphography with MIP reconstruction (b) demonstrated a channel type lymphatic malformation (arrows) in contact with the right renal pelvis and right ureter
Fig. 6
Fig. 6
44-year-old female patient with chyluria. Sagittal T2-weighted MR image (a) and T1-weighted MR image with fat saturation (b) demonstrated an intravesical fat-fluid level (arrows) and chylous clot (C). Coronal MR lymphography with MIP reconstructionc demonstrated a channel type lymphatic malformation (arrows) in touch with both faces of the bladder. Coronal MR lymphography with MIP reconstruction (d) demonstrated bilateral lower limb lymphedema (L) that was more severe on the left side with dilatation of lymphatic vessels (arrows). Corresponding coronal T2-weighted MR image (e) showed bilateral congenital deformities of the ankles and feet
Fig. 7
Fig. 7
17-year-old female patient with chyluria and vaginal chylous discharge. Coronal T2-weighted MR imagea demonstrated abnormal lymphatic vessels in the abdomen, pelvis, and retroperitoneum, which were better seen with (b) coronal MR lymphography with MIP reconstruction. Dilated lymphatic vessels (arrows) close to the bladder, ureters, colon, and uterine cervix were also demonstrated.R right kidney,L left kidney. This patient also presented with right lower limb lymphedema (L) and cystic lymphatic malformations (arrows) on coronal MR lymphography with MIP reconstruction (c)
Fig. 8
Fig. 8
17-year-old male patient with chyluria, hydrocele, and bilateral lymphedema of the lower limbs. Coronal T2-weighted MR image (a) and coronal MR lymphography with MIP reconstructionb demonstrated widespread dilated lymphatic vessel development along the urinary tract from the retroperitoneum to the bladder (arrows).R right kidney,L left kidney. Coronal MR lymphography with MIP reconstruction (c) demonstrated major lymphatic dysplasia at the root of the left lower limb (arrows) and the presence of several cystic lymphatic malformations (arrowhead) of the soft tissues
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References

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