Thoracic duct lymphangioma and chylous ascites in a 24-year-old female

Lymphangiomas are rare and correspond to 0.7% to 4.0% of mediastinal tumors, and isolated mediastinal location occurs in 1% of cases. They are benign tumors that originate from a congenital malformation of the lymphatic vessels and are diagnosed more frequently in children less than 2 years of age. Chylous ascites is a clinical manifestation of thoracic duct lymphangioma and is composed of lymph accumulation caused by dilation of this lymphatic channel. It appears milky in the peritoneal cavity, containing triglyceride levels higher than 200 mg/dl. We report the case of a young patient with chylous ascites and lymphangioma of the thoracic duct, who was conservatively treated with octreotide and a low-fat diet with medium-chain triglycerides.

Keywords:
Chylous Ascites; Lymphangioma; Octreotide; Thoracic Duct; Treatment

Authorship

Larissa Moreira Galvão Bello

Hospital das Forças Armadas (HFA), Departamento de Medicina, Brasília, DF, BrasilHospital das Forças ArmadasBrasilBrasília, DF, BrasilHospital das Forças Armadas (HFA), Departamento de Medicina, Brasília, DF, Brasil

https://orcid.org/0000-0002-5714-7818

Vitorino Modesto dos Santos

Universidade Católica de Brasília, Curso de Medicina, Brasília, DF, BrasilUniversidade Católica de BrasíliaBrasilBrasília, DF, BrasilUniversidade Católica de Brasília, Curso de Medicina, Brasília, DF, Brasil

https://orcid.org/0000-0002-7033-6074

Márcia Mayumi Marques Suzuki

https://orcid.org/0000-0003-0847-5214

Naiara Regina Siqueira

https://orcid.org/0000-0001-8230-5104

Fernanda Gonçalves Reis

https://orcid.org/0000-0001-7618-3892

Authors’ contributions: Larissa Moreira Galvão Bello, Márcia Mayumi Marques Suzuki, and Fernanda Gonçalves Reis treated clinically the patient, and Naiara Regina Siqueira performed the imaging evaluations. Vitorino Modesto dos Santos and all the other authors collectively designed the article, and reviewed and approved the manuscript’s final version for publication.

Conflict of interest: None.

CorrespondenceVitorino Modesto dos Santos Armed Forces Hospital Estrada do Contorno do Bosque s/n, Cruzeiro Novo, 70.658-900, Brasília, DF, Brasil Phone: +55 61 3966-2103vitorinomodesto@gmail.com

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Figures

Figures (4)

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Figure 1
Thoracic and abdominal enhanced computed tomography. A – axial plane and B coronal plane – images at admission showing a cystic image (black arrow) in the thoracic duct site at the thoracic-abdominal transition, well-defined and without enhancement in contact with the aorta (black asterisk), and associated with ascites (white asterisks), C – sagittal plane and D axial plane showing ascites (white asterisks) and bilateral laminar pleural effusion, as well as the bladder (#) and the uterus (black asterisk).

Thumbnail

Figure 2
Axial MRI sections of the chest showing a cystic image in the topography of the thoracic duct (arrow) characterized by A – a low signal in the T1-weighted sequence; B – a high signal in the T2-weighted sequence; associated with C – small pleural effusion and ascites (asterisks); the cyst is also evident (arrow) in the coronal section on the T2-weighted sequence, and D – without enhancement in the T1-weighted sequence after contrast injection.

Thumbnail

Figure 3
Gross view of the milky-like liquid collected on the drainage of the ascites.

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Figure 4
Contrast-enhanced CT scan of the abdomen after drainage, A – shows a significant reduction in ascites (white asterisk) and partially drainage (arrow) in the sagittal plane, in addition to the uterus (black asterisk) and the bladder (#); B – the coronal section image, confirms the total regression of ascites detected in the admission exam; C and D – Contrast-enhanced chest CT scan after drainage, C - axial section, and mediastinal window shows the close relationship between the cyst and the thoracic duct (black asterisk) and other structures such as the descending aorta (#), the azygous vein (white asterisk) and the esophagus (arrowhead); it also reveals the absence of pleural effusion; D - sagittal section shows the major diameter of the cyst at the site of the thoracic duct (long arrow), its location in the posterior mediastinum and the relationship with the esophagus (short arrow), the right ventricle (black asterisk), and the azygous vein (white asterisk).

Figure 1 Thoracic and abdominal enhanced computed tomography. A – axial plane and B coronal plane – images at admission showing a cystic image (black arrow) in the thoracic duct site at the thoracic-abdominal transition, well-defined and without enhancement in contact with the aorta (black asterisk), and associated with ascites (white asterisks), C – sagittal plane and D axial plane showing ascites (white asterisks) and bilateral laminar pleural effusion, as well as the bladder (#) and the uterus (black asterisk).

Figure 2 Axial MRI sections of the chest showing a cystic image in the topography of the thoracic duct (arrow) characterized by A – a low signal in the T1-weighted sequence; B – a high signal in the T2-weighted sequence; associated with C – small pleural effusion and ascites (asterisks); the cyst is also evident (arrow) in the coronal section on the T2-weighted sequence, and D – without enhancement in the T1-weighted sequence after contrast injection.

Figure 3 Gross view of the milky-like liquid collected on the drainage of the ascites.

Figure 4 Contrast-enhanced CT scan of the abdomen after drainage, A – shows a significant reduction in ascites (white asterisk) and partially drainage (arrow) in the sagittal plane, in addition to the uterus (black asterisk) and the bladder (#); B – the coronal section image, confirms the total regression of ascites detected in the admission exam; C and D – Contrast-enhanced chest CT scan after drainage, C - axial section, and mediastinal window shows the close relationship between the cyst and the thoracic duct (black asterisk) and other structures such as the descending aorta (#), the azygous vein (white asterisk) and the esophagus (arrowhead); it also reveals the absence of pleural effusion; D - sagittal section shows the major diameter of the cyst at the site of the thoracic duct (long arrow), its location in the posterior mediastinum and the relationship with the esophagus (short arrow), the right ventricle (black asterisk), and the azygous vein (white asterisk).

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Thoracic duct lymphangioma and chylous ascites in a 24-year-old female

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[1] Authors’ contributions: Larissa Moreira Galvão Bello, Márcia Mayumi Marques Suzuki, and Fernanda Gonçalves Reis treated clinically the patient, and Naiara Regina Siqueira performed the imaging evaluations. Vitorino Modesto dos Santos and all the other authors collectively designed the article, and reviewed and approved the manuscript’s final version for publication.