Traumatic chyluria as displayed by lymphangiogram

Chyluria is the presence of chyle in the urine, giving it a milky appearance. Chyle is the milky fluid taken up by the lacteals from the food in intestine after digestion. It consists of lymph and emulsified fat. It passes into the veins by the thoracic duct, becoming mixed with the blood. When there is extravasation of chyle into the thorax it is called chylothorax in the abdomen, chylous ascites. Causes of chyluria include parasitic by the filarial parasite Wuchereria bancrofti ; surgical such as aortoiliac grafting, and traumatic. Bipedal lymphangiogram displays the initial and delayed radiographic drainage of the lower extremities, pelvis, abdomen and the thoracic lymph duct drainage into the subclavian veins. Fluoroscopic control detects extravasation and circumvention of the Ethiodal contrast into the abnormal communication of the lymphatics into the pelvis of the kidney and into the bladder. The site of extravasation and abnormal communication may be detected at surgery by open observation or by methylene blue injected into the digits of the feet. Surgical correction is by tying off the abnormal lymphatic communication and/or the thoracic duct. If not corrected, the patient will develop a protein‐losing enteropathy. Three patients with chyluria were selected for this presentation with parasitic, surgical and traumatic chyluria (football injury to the abdomen). The traumatic chyluria displayed considerable loss of weight, and was corrected at surgery.