Idiopathic chylothorax-chylous ascites - A case report

A 43-year-old woman was admitted because of right lower abdominal pain. There was no significant past medical or family history. Physical examination revealed right lower quadrant tenderness and rebound tenderness. A peripheral blood count showed a WBC count of 6800 cells/mm³. CRP was 2.1. A chest radiograph revealed the presence of bilateral pleural effusion. An abdominal CT scan sowed right prerenal fluid collection in the retro peritoneal space and perirectal ascites. US-guide aspiration of the ascetic fluid from Douglas' cul-de-sac yieled approximaterly 10 ml of milky fluid. The patient was treated conservatively and examined to determine the etiology of the chylous ascites. The pleural effusion consisted of approximately 240 ml of milky fluid. Lymphangioscintigrahy with ^99mTc-HAS shwed decreased lymph flow around the external iliac lymph nodes, but no leakage of ^99mTc-HAS into the thoracic cavity or abdominal cavity was detected. The lymphagiography findings were similar to those obtained by lymphagioscintigraphy. The WBC count decreased and the abdominal pain and rebound tenderness resolved in response to conservative therapy with no oral intake and parenteral nutrition. Five days after the onset of symptoms, the patient was placed on a fat-free diet. Based on the clinical and laboratory findings taken as a whole, a diagnosis of idiopathic chylothorax-chylous ascites was made. The clinical course was good, and the pleural effusion and ascites gradually resolved, allowing the patient to be discharged 18 days after the onset of symptoms. At the present, seven months after her discharge, she shows no evidence of recurrence of chylothorax-chylous ascites.