Effective Intractable Chylous Ascites Treatment by Lymphangiography with Lipiodol in a Patient with Follicular Lymphoma.

A 66-year-old woman was diagnosed with stage IV follicular lymphoma with a large tumor extending from the celiac artery to pelvis. Initial chemotherapy improved her lymphoma, but caused severe chylous ascites, requiring frequent paracentesis. Lymphoscintigraphy revealed radioisotope leakage into the abdominal cavity at the level of the renal hilum, indicating lymphatic vessel perforation. Lymphangiography with Lipiodol quickly resolved the chylous ascites. This case indicates that refractory chylous ascites with shrinking retroperitoneal lymphoma may require direct intervention in lymphatic vessels, and lymphangiography with Lipiodol may be effective not only as a tool for diagnosing lymphatic leakage sites but also as a treatment for lymphatic vessel damage.