Since the pathology of this disorder lies deeper, the mere ablation of the vesicles will lead to frequent recurrences as witnessed in our patient. The surgical options also include excision, ligation, or sclerotherapy of the incompetent lymphatics, which can be combined with lymphovenous anastomosis or lymphatic bypass grafting. The aim of definitive surgical treatment is to stop the chylous reflux by diminishing retrograde flow of chyle and diverting the incompetent lymphatics into the venous system. However, lymphangiography could not be done due to patient's financial constraints. In the present case, lymphoscintigraphy showed backflow of the chyle into the genitalia. Magnetic resonance imaging also delineates the dilated lymphatics. Lymphangiography is more confirmatory as it exactly depicts the dilated retroperitoneal lymphatics and localizes the site of chyle reflux. LinkedIn is the worlds largest business network, helping professionals like.
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Lymphoscintigraphy is an initial diagnostic test. View Akila Balasubramanian MD,MBA,FAAFPS professional profile on LinkedIn. The milky white color distinguishes this entity from the mere lymphangiectasia where clear fluid will be contained in the vesicles. In our patient, the fluid from vesicles was milky and odorless, had specific gravity more than 1.012, and had elevated triglycerides. She is very thorough and kind and it is easy to get an appointment within. The characteristic features of the chylous fluid from the lymphangiectatic vesicles are as follows: Bala, has been my physician for over 15 years. Malnutrition due to depletion of lipids and proteins and impaired immunity due to loss of immunoglobulins may occur. They also serve as entry point of bacteria causing cellulitis or lymphangitis. The discharge of chyle from cutaneous vesicles interferes greatly with quality of life. Primary chylous lymphangiectasia of the genitalia presents as edema of the genitalia, persistent vaginal discharge of chylous fluid, or lymphangiectatic vesicles which when ruptured extrude milky fluid mixed with chyle and lymph, similar to the present case.Īlthough this entity is congenital, onset occurs commonly during teenage (age of onset ranging between 1 day and 81 years). These features are postulated to be due to the valvular incompetence of the lymphatic channels or atresia of the lymphatics at or above the level of the cisterna chyli. The other presentations of chylous reflux include chylothorax, chylous ascites, chyloptysis, chylopericardium, chyluria, intestinal lymphangiectasia (manifesting as protein-losing enteropathy), and edema of the lower extremities. Primary developmental abnormalities of the lymph vessels (lymphangiectasia) or secondary causes (tumor and trauma) lead to accumulation of the chyle and disruption of the lymphatics, causing chylous lymphangiectasia in the genitalia (scrotum in male and labia in female), perineum, or legs. Best wishes Dr Greengold Appreciate your teaching in the residency program. Profile, Reviews, Appointments, Insurances. Lacteals of the small intestine and the lymphatics from the lower limbs and genitalia drain into the cisterna chyli. Akila Balasubramanian, MD, Family Practitioner in Casselberry, FL, 32707.
The scope of family medicine is not limited by age, sex, organ system, or disease entity.Chyle is a milky fluid which is a mixture of lymph (from the genitalia and lower limb) and fat (absorbed from the small intestine). It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. Include annual exams, immunizations, medication refills, hormone level testing, cardiovascular testing, pap smears and genital exams, specialist referrals, and patient education.įamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. Medical tests, procedures and therapies provided by Family Medicine Doctors Ricardo Pascual Vazquez, MD, is a General Practice specialist in Casselberry, Florida. Significant diseases and conditions treated byįamily Medicine Doctors include cold and flu, asthma and allergies, ear and eye infections, yeast infections, diabetes, high blood pressure, hormone imbalance, nutritional imbalance, stress and depression, muscle tears and sprains, and sexually transmitted diseases.
Family Medicine isĪ medical specialty devoted to the medical care of the family unit. Medical history analysis, diagnostics, and treatments for a wide variety of dysfunctions, conditions, and injuries. With special training and skill in family-centric healthcare.Īs a Family Medicine Doctor, Akila Balasubramanian, MD performs Akila Balasubramanian is a Family Medicine Doctor in Casselberry, FL