eMedicine Specialties > General Surgery > Head and Neck

Perilymph Fistula: Workup

Author: Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University
Coauthor(s): Joshua N Honeyman, Brown Medical School; Nicholas J Gargiulo III, MD, Staff Physician, Department of Surgery, Albert Einstein College of Medicine; Frank J Veith, MD, The William J von Liebig Chair in Vascular Surgery, Vice Chairman, Department of Surgery, Montefiore Medical Center; Clinical Visiting Professor, Department of Surgery, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Apr 29, 2008

Workup

Laboratory Studies

  • The presence of chyle may be confirmed in the laboratory by measuring fat and protein content, pH, and specific gravity. Chyle has a fat content of 0.4-4.0 g/dL, a protein content of approximately 3 g/dL, a pH of greater than 7.5, and a specific gravity of greater than 1.010 g/dL.
  • Lymphopenia and anemia may occur.

Imaging Studies

  • Lymphatic fistula  
    • Lymphoscintigraphy may be used to confirm that clear yellow drainage from an infrainguinal incision is of lymphatic origin. Lymphangiography was used for diagnostic purposes before the development of lymphoscintigraphy, but it carried a much higher complication rate.
    • CT scans may be used to exclude underlying prosthetic graft infections following infrainguinal reconstruction.
    • Fistulography and white blood cell scanning are other diagnostic tools that may be used to help diagnose lymphatic fistulae.
  • Chylous ascites: Abdominal ultrasonography and/or abdominal CT scans may confirm the presence of significant amounts of free fluid consistent with chylous ascites.
  • Chylothorax: Chest x-ray films and/or chest CT scans confirm the presence of an effusion.

Other Tests

  • Infrainguinal wound drainage may be sent for laboratory confirmation of chyle. The demonstration of chyle within infrainguinal wound drainage confirms that the drainage is of lymphatic origin.

Diagnostic Procedures

  • Traditional, ultrasonographic, or CT scan–directed paracentesis may be performed to confirm the presence of chylous ascites.
  • Chylothorax may be demonstrated by diagnostic/therapeutic thoracentesis.
  • Tube thoracostomy may be used for diagnosis and conservative treatment of chylothorax.

Histologic Findings

No major histologic findings exist for chyle or for the diagnosis of lymphatic fistulae, chylous ascites, or chylothorax.

Staging

No formal clinical staging system currently exists for lymphatic fistulae, chylous ascites, or chylothorax.

More on Perilymph Fistula

Overview: Perilymph Fistula
Workup: Perilymph Fistula
Treatment: Perilymph Fistula
Follow-up: Perilymph Fistula
References
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References

  1. Kalman PG, Walker PM, Johnston KW. Consequences of groin lymphatic fistulae after vascular reconstruction. Vasc Surg. 1991;25:210-213.

  2. Huang Q, Jiang ZW, Jiang J, Li N, Li JS. Chylous ascites: treated with total parenteral nutrition and somatostatin. World J Gastroenterol. Sep 1 2004;10(17):2588-91. [Medline].

  3. Kelly RF, Shumway SJ. Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg. Jun 2000;69(6):1944-5. [Medline].

  4. Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol. Nov 2002;13(11):1139-48. [Medline].

  5. Fairfax AJ, McNabb WR, Spiro SG. Chylothorax: a review of 18 cases. Thorax. Nov 1986;41(11):880-5. [Medline].

  6. Gloviczki P, Lowell RC. Lymphatic complications of vascular surgery. In: Rutherford RB, ed. Vascular Surgery. Philadelphia: WB Saunders Co; 2001:781-789.

  7. McKenna R, Stevick CA. Chylous ascites following aortic reconstruction. Vasc Surg. 1983;17:143-149.

  8. Pabst TS 3rd, McIntyre KE Jr, Schilling JD, Hunter GC, Bernhard VM. Management of chyloperitoneum after abdominal aortic surgery. Am J Surg. Aug 1993;166(2):194-8; discussion 198-9. [Medline].

  9. Roberts JR, Walters GK, Zenilman ME, Jones CE. Groin lymphorrhea complicating revascularization involving the femoral vessels. Am J Surg. Mar 1993;165(3):341-4. [Medline].

  10. Savrin RA, High R. Chylous ascites after abdominal aortic surgery. Surgery. Nov 1985;98(5):866-9. [Medline].

  11. Shermak MA, Yee K, Wong L, Jones CE, Wong J. Surgical management of groin lymphatic complications after arterial bypass surgery. Plast Reconstr Surg. Jun 2005;115(7):1954-62. [Medline].

  12. Tyndall SH, Shepard AD, Wilczewski JM, Reddy DJ, Elliott JP Jr, Ernst CB. Groin lymphatic complications after arterial reconstruction. J Vasc Surg. May 1994;19(5):858-63; discussion 863-4. [Medline].

  13. Vargas FS, Milanez JR, Filomeno LT, Fernandez A, Jatene A, Light RW. Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. Chest. Dec 1994;106(6):1771-5. [Medline].

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Further Reading

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Keywords

lymphatic fistula, lymphocele, thoracic duct fistula, chylous ascites, chylothorax, abdominal aortic reconstruction, laparotomy, total parenteral nutrition, TPN, lymphoscintigraphy, vascular reconstruction, lymphatic system

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Contributor Information and Disclosures

Author

Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University
Howard L Kaufman, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, Association for Academic Surgery, Illinois State Medical Society, Massachusetts Medical Society, New York Academy of Sciences, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Coauthor(s)

Joshua N Honeyman, Brown Medical School
Disclosure: Nothing to disclose.

Nicholas J Gargiulo III, MD, Staff Physician, Department of Surgery, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

Frank J Veith, MD, The William J von Liebig Chair in Vascular Surgery, Vice Chairman, Department of Surgery, Montefiore Medical Center; Clinical Visiting Professor, Department of Surgery, Uniformed Services University of the Health Sciences
Disclosure: Vascular Innovation Ownership interest Other

Medical Editor

Alex Jacocks, MD, Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

CME Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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