Effective Intractable Chylous Ascites Treatment by Lymphangiography with Lipiodol in a Patient with Follicular Lymphoma.

in Internal medicine (Tokyo, Japan) by Ryohei Sumitani, Kohei Higashi, Masahiro Oura, Yusaku Maeda, Hikaru Yagi, Kimiko Sogabe, Mamiko Takahashi, Takeshi Harada, Shiro Fujii, Hirokazu Miki, Masahiro Abe, Shingen Nakamura

TLDR

  • This study is about a woman with a type of cancer called follicular lymphoma. She had a big tumor that was causing a lot of fluid to build up in her belly. The fluid was so bad that she needed to have it drained frequently. The doctors found out that the fluid was coming from a problem with her lymphatic vessels, which are like tiny tubes that carry fluid around the body. They used a special test called lymphoscintigraphy to find the source of the problem. Then they used another test called lymphangiography with Lipiodol to fix the problem and stop the fluid from building up. The study shows that this treatment might be helpful for other people with similar problems.

Abstract

A 66-year-old woman was diagnosed with stage IV follicular lymphoma with a large tumor extending from the celiac artery to pelvis. Initial chemotherapy improved her lymphoma, but caused severe chylous ascites, requiring frequent paracentesis. Lymphoscintigraphy revealed radioisotope leakage into the abdominal cavity at the level of the renal hilum, indicating lymphatic vessel perforation. Lymphangiography with Lipiodol quickly resolved the chylous ascites. This case indicates that refractory chylous ascites with shrinking retroperitoneal lymphoma may require direct intervention in lymphatic vessels, and lymphangiography with Lipiodol may be effective not only as a tool for diagnosing lymphatic leakage sites but also as a treatment for lymphatic vessel damage.

Overview

  • The study focuses on a 66-year-old woman with stage IV follicular lymphoma who developed refractory chylous ascites after initial chemotherapy. The methodology involves lymphoscintigraphy and lymphangiography with Lipiodol to diagnose and treat lymphatic vessel damage. The primary objective is to demonstrate the effectiveness of lymphangiography with Lipiodol in resolving chylous ascites in this case.

Comparative Analysis & Findings

  • The study compares the outcomes of the patient's initial chemotherapy treatment with the subsequent lymphangiography with Lipiodol. The initial chemotherapy improved the lymphoma but caused severe chylous ascites, requiring frequent paracentesis. In contrast, lymphangiography with Lipiodol resolved the chylous ascites and did not cause any further complications. The key finding of the study is that lymphangiography with Lipiodol may be effective in treating lymphatic vessel damage and resolving chylous ascites in refractory cases.

Implications and Future Directions

  • The study's findings suggest that lymphangiography with Lipiodol may be a useful tool for diagnosing and treating lymphatic vessel damage in refractory chylous ascites cases. However, the study is limited by its small sample size and the patient's unique medical history. Future research should investigate the effectiveness of lymphangiography with Lipiodol in a larger cohort of patients with refractory chylous ascites and compare it to other treatment options. Additionally, further studies should explore the potential risks and complications associated with lymphangiography with Lipiodol to ensure its safe and effective use in clinical practice.
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