Perilymph Fistula Workup

  • Author: Howard L Kaufman, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Nov 28, 2011
 

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.
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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.[3]
    • 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.
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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.
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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.
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Histologic Findings

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

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Staging

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

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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  Professor of Surgery, The Cleveland Clinic and New York University School of Medicine, The William J von Liebig Chair in Vascular Surgery, The Cleveland Clinic

Disclosure: Nothing to disclose.

Specialty Editor Board

Alex Jacocks, MD  Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, 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 Consulting; ARdelyx Ownership interest Board membership

References

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

  2. Fukunaga N, Shomura Y, Nasu M, Okada Y. Chylous ascites as a rare complication after abdominal aortic aneurysm surgery. South Med J. May 2011;104(5):365-7. [Medline].

  3. Burnand KM, Glass DM, Sundaraiya S, Mortimer PS, Peters AM. Popliteal node visualization during standard pedal lymphoscintigraphy for a swollen limb indicates impaired lymph drainage. AJR Am J Roentgenol. Dec 2011;197(6):1443-8. [Medline].

  4. 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].

  5. Yildirim AE, Altun R, Can S, Ocal S, Akbas E, Korkmaz M, et al. Idiopathic chylous ascites treated with total parenteral nutrition and octreotide. A case report and review of the literature. Eur J Gastroenterol Hepatol. Oct 2011;23(10):961-3. [Medline].

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

  11. 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].

  12. 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].

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

  14. 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].

  15. 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].

  16. 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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