Scrotal Chylorrhoea: Images of Uncommon Scrotal Fluid Discharge
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Images in Clinical Urology Scrotal Chylorrhoea: Images of Uncommon Scrotal Fluid Discharge Ankush Gupta, Divakar Dalela, Pawan Vasudeva, S. N. Sankhwar, and Apul Goel Chylous discharge or “chylorrhea” from the scrotum secondary to filariasis is an infrequent manifestation. With the availability of effective medical therapy for filariasis, it has become even more unusual. We report on 2 patients who presented to us with a persistent milky white discharge from the vesicles on the scrotal surface, which otherwise showed no evidence of elephantiasis. UROLOGY 73: 1227–1228, 2009. © 2009 Elsevier Inc. T wo middle-age men presented with a persistent milky white discharge (Fig. 1) from tiny vesic- ular eruptions on the scrotum (Figs. 2 and 3) of 5-6 months’ duration. The discharge was profuse enough to cause wetting of the undergarments and hamper their daily life. Neither patient had a history of surgery or trauma. The physical examination showed no lymphedema of the lower limbs or scrotum. The laboratory evaluation and abdominopelvic imaging findings were all within normal limits. Fluid collected from the vesicular surface was positive for triglycerides. A filarial etiology presumed because of endemicity. Both patients were effectively treated with compres- sion dressings with hypertonic saline for 1 week and long-term diethylcarbamazine therapy. Chylorrhea occurs because of a backflow of chyle from its normal route. 1 Primary chylous reflux describes an idiopathic etiology. Secondary chylous reflux can be due to irradiation, malignancy, surgery, trauma, or filarialiasis. 2 Lymphography showed the presence of reflux from the inguinal lymphatics into the scrotum. 3 From the Department of Urology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India Reprint requests: Ankush Gupta, M.S., Department of Urology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh 226003 India. E-mail: [email protected] Submitted: December 5, 2008, accepted (with revisions): January 12, 2009 Figure 2. Vesicular eruptions filled with milky white fluid on scrotal surface (no evidence of scrotal elephantiasis). Figure 3. Spurt of chyle (arrow) emanating from vesicle. Figure 1. Chyle dripping from scrotum. © 2009 Elsevier Inc. 0090-4295/09/$34.00 1227 All Rights Reserved doi:10.1016/j.urology.2009.01.005
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Transcript of Scrotal Chylorrhoea: Images of Uncommon Scrotal Fluid Discharge
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Images in Clinical Urology
crotal Chylorrhoea: Imagesf Uncommon Scrotal Fluid Discharge
nkush Gupta, Divakar Dalela, Pawan Vasudeva, S. N. Sankhwar, and Apul Goel
hylous discharge or “chylorrhea” from the scrotum secondary to filariasis is an infrequent manifestation. With thevailability of effective medical therapy for filariasis, it has become even more unusual. We report on 2 patients whoresented to us with a persistent milky white discharge from the vesicles on the scrotal surface, which otherwise showed
o evidence of elephantiasis. UROLOGY 73: 1227–1228, 2009. © 2009 Elsevier Inc.iidfi
Fs
wo middle-age men presented with a persistentmilky white discharge (Fig. 1) from tiny vesic-ular eruptions on the scrotum (Figs. 2 and 3) of
-6 months’ duration. The discharge was profusenough to cause wetting of the undergarments andamper their daily life. Neither patient had a history ofurgery or trauma. The physical examination showedo lymphedema of the lower limbs or scrotum. The
aboratory evaluation and abdominopelvic imagingndings were all within normal limits. Fluid collectedrom the vesicular surface was positive for triglycerides.
filarial etiology presumed because of endemicity.oth patients were effectively treated with compres-
ion dressings with hypertonic saline for 1 week andong-term diethylcarbamazine therapy.
rom the Department of Urology, Chhatrapati Shahuji Maharaj Medical University,ucknow, Uttar Pradesh, IndiaReprint requests: Ankush Gupta, M.S., Department of Urology, Chhatrapati
hahuji Maharaj Medical University, Lucknow, Uttar Pradesh 226003 India. E-mail:
Figure 1. Chyle dripping from scrotum.
Submitted: December 5, 2008, accepted (with revisions): January 12, 2009
2009 Elsevier Inc.ll Rights Reserved
Chylorrhea occurs because of a backflow of chyle fromts normal route.1 Primary chylous reflux describes andiopathic etiology. Secondary chylous reflux can beue to irradiation, malignancy, surgery, trauma, orlarialiasis.2 Lymphography showed the presence of
igure 2. Vesicular eruptions filled with milky white fluid oncrotal surface (no evidence of scrotal elephantiasis).
Figure 3. Spurt of chyle (arrow) emanating from vesicle.
eflux from the inguinal lymphatics into the scrotum.3
0090-4295/09/$34.00 1227doi:10.1016/j.urology.2009.01.005
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he goal of therapy is to reduce the chylous reflux.4
ost cases can be managed conservatively with a low-at diet, diuretics, antibiotics, and compression garments.
selected few will require resection of the retro-eritoneal and mesenteric lymphatics with or withoutclerotherapy. Our experience with hypertonic salineompressive dressing has been good but needs more
ollow-up.228
eferences
. Chern LC, Lin CS, Wong CK. Cutaneous chylous reflux. Br JDermatol. 1989;120:695-700.
. Huang HY, Hu SL. Scrotal cutaneous chylous reflux. Br J Dermatol.2007;156:752-754.
. Lim ST, Ngan H, Wong KK, et al. Leakage of lymph through scrotalskin. J Urol. 1981;125:889-890.
. Noel AA, Gloviczki P, Bender CE, et al. Treatment of symptomatic
primary chylous disorders. J Vasc Surg. 2001;34:785-791.UROLOGY 73 (6), 2009
