1 Department of Nephrology and 2 Department of Radiology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
Correspondence and offprint requests to: Bart Maes, Department of Nephrology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Email: bart.maes{at}uz.kuleuven.ac.be
Keywords: chyluria; ductus thoracicus obstruction
A 39-year-old white male with a history of subtotal thyroidectomy was referred because of intermittent nightly voiding of milky urine for a period of 1 year, suggestive of chyluria. Urine analysis revealed periodical proteinuria up to 3.8 g/day, triglyceriduria (137 mg/dl) and chylomicronuria. Screening for infectious disease and urological abnormalities was negative. Both kidneys and the renal pelvis were normal. There was no indication of lymph leakage to the renal collecting system at bipedal 99mTc-DTPA (diethylenetriamine penta-acetic acid)-albumin lymphography. Magnetic resonance imaging (MRI) revealed both a dilated and tortuous thoracic duct from the suprarenal area to the outlet in the anonymous vein [Figure 1A, axial T2-weighted; C, coronal maximum intensity projection (MIP) and rapid acquisition relaxation enhancement (RARE)] and dilated retroperitoneal lymph vessels extending to the renal hilum (Figure 1B, coronal T2-weighted). A contrast-enhanced chest computed tomography (CT) scan excluded external compression of the anonymous vein. Since clinical and biochemical parameters remain stable, no invasive repair has been attempted up to the present.
|
Conflict of interest statement. None declared.
|