Lymphatic Leakage Clinical Presentation

Updated: Apr 24, 2017
  • Author: Michael Omidi, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
  • Print
Presentation

History and Physical Examination

The diagnosis of a lymphatic fistula may be established by the leakage of clear yellow fluid from an infrainguinal incision that occurs days to months after infrainguinal vascular reconstruction. A lymphocele may be diagnosed by the presence of lymphatic drainage in a soft, fluid-filled cyst.

Patients with chylous ascites usually develop progressive abdominal distention and pain accompanied by nausea and vomiting several days to weeks following abdominal aortic reconstruction. The presence of a fluid wave indicating ascites may be appreciated on abdominal examination. Lymphopenia and anemia may also develop.

The presence of decreased breath sounds at the lung bases and dullness to percussion may suggest the presence of an effusion and chylothorax. Pulmonary compromise ensues several days after thoracoabdominal aortic reconstruction or repair of aortic coarctation. Hematologic depression, such as lymphopenia and anemia, may also develop.

Next:

Classification

Chylothorax is often classified according to output, as follows [9, 15, 19, 20, 21, 22, 14] :

  • High output (>1000 mL/day)
  • Low output (<500 mL/day)

Other authors have categorized chylous ascites as high-output when more than 7000 mL is obtained by paracentesis. [11]  Low-output chylous leakage (<500 mL/day) can often be successfully treated with medical therapy. [23]

Previous