MRI as Non-Invasive Modality of Choice for Diagnosis of Cause in Case of Chyluria

Kishor Taori, Amit Disawal, Jawahar Rathod, Rakhi P. Puria, Prasad Wavare, Vishal N. Bakare, Anand Hatgaonkar, Suresh Dhakate

Department of Radio-Diagnosis, Government Medical College and Hospital, Nagpur, India.

DOI: 10.4236/ojneph.2013.31002                

Abstract

Chyluria is a urological manifestation of lymphatic system abnormality as a result of some abnormal communication between these two systems. Although chyluria as such is rare, filariasis is most common cause in Asian countries. This parasitic tropical debilitating disease is known for chronicity, recurrence and resultant complications. This article provides importance of Magnetic Resonance Imaging (MRI), as a non-invasive modality, in the diagnosis of exact etiopathogenesis of chyluria along with clinical symptoms, other investigations required and brief about the management protocols. On MRI, abnormally dilated lymphatics are visualized as meshwork of multiple tubular, tortuous, fluid-filled structures in the retroperitoneum. We report a case of 20 year young adult who presented with history of passing whitish urine on and off since 8 months. MRI helped in the detection of the site and level of lymphatic obstruction and resultant lympho-urinary fistula.

Keywords

MRI; Retroperitoneum; Dilated Lymphatics; Chyluria; Filariasis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	U. T. Aye and S. T. T. Aung, “Chyluria,” Clinical Radiology, Vol. 26, No. 2, 1975, pp. 237-242.
[2]	H. Ngan and C. H. Leong, “A Lymphographic Study of Chyluria,” British Journal of Radiology, Vol. 50, No. 600, 1977, pp. 863-870. doi:10.1259/0007-1285-50-600-863
[3]	A. K. Hemal and N. P. Gupta, “Retroperitoneoscopic Lymphatic Management of Intractable Chyluria,” Journal of Urology, Vol. 167, No. 6, 2002, pp. 2473-2476. doi:10.1016/S0022-5347(05)65007-0
[4]	S. Sharma and A. K. Hemal, “Chyluria—An Overview,” Nephro-Urology Monthly, Vol. 1, No. 1, 2009, pp. 14-26.
[5]	P. R. Nandy, U. S. Dwivedi, N. Vyas, M. Prasad, B. Dutta and P. B. Singh, “Povidone Iodine and Dextrose Solution Combination Sclerotherapy in Chyluria,” Urology, Vol. 64, No. 6, 2004, pp. 1107-1109. doi:10.1016/j.urology.2004.07.035
[6]	V. K. Mehta, H. Lohar, G. K. Banerjee, M. V. Reddy and B. C. Harinath, “Surgical Filariasis: Immunoscreening for Filarial IgG Antibodies Using Wuchereria Bancrofti Microfilarial Excretory-Secretory Antigen,” Journal of Communicable Diseases, Vol. 31, No. 1, 1999, pp. 35-40.
[7]	X. Zhang, Z. Q. Ye, Z. Chen, Z. Q. Chen, Q. G. Zhu, M. Xin, et al., “Comparison of Open Surgery versus Retroperitoneoscopic Approach to Chyluria,” Journal of Urology, Vol. 169, No. 3, 2003, pp. 991-993. doi:10.1097/01.ju.0000045090.45767.56
[8]	S. Govil, A. Justus, R. Lakshminarayanan, S. Nayak, A. Devasia and G. Gopalakrishnan, “Retroperitoneal Lymphatics on CT and MR,” Abdominal Imaging, Vol. 32, No. 1, 2007, pp. 53-55. doi:10.1007/s00261-006-9036-9
[9]	A. Geliebter, N. Torbay, E. F. Bracco, S. A. Hashim and T. B. Van Itallie, “Overfeeding with Medium-Chain Triglyceride Diet Results in Diminished Deposition of Fat,” American Journal of Clinical Nutrition, Vol. 37, No. 1, 1983, pp. 1-4.
[10]	K. N. Panicker, N. Arunachalam, N. P. Kumar, J. Prathibha and S. Sabesan, “Efficacy of Diethylcarbamazine-Medicated Salt for Microfilaraemia of Brugia Malayi,” National Medical Journal of India, Vol. 10, No. 6, 1997, pp. 275-276.