Chylous Ascites Differential Diagnosis
The differential diagnosis for chylous ascites can be organized into the following categories:
- Single most likely diagnosis
- Lymphatic obstruction or disruption (e.g., due to malignancy, surgery, or trauma): This is the most common cause of chylous ascites, as it leads to the leakage of lymphatic fluid into the peritoneal cavity.
- Other Likely diagnoses
- Cirrhosis: Liver cirrhosis can cause chylous ascites due to the increased pressure in the lymphatic vessels.
- Nephrotic syndrome: Severe protein loss in the urine can lead to hypoalbuminemia, which can cause chylous ascites.
- Heart failure: Right-sided heart failure can increase the pressure in the lymphatic vessels, leading to chylous ascites.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignancy (e.g., lymphoma, ovarian cancer): Certain types of cancer can cause chylous ascites, and early diagnosis is crucial for treatment.
- Tuberculosis: Abdominal tuberculosis can cause chylous ascites, and it requires prompt treatment to prevent complications.
- Congenital lymphatic anomalies: Rare congenital conditions, such as lymphangiectasia, can cause chylous ascites.
- Rare diagnoses
- Whipple's disease: A rare bacterial infection that can cause malabsorption and chylous ascites.
- Sarcoidosis: A rare autoimmune disease that can cause inflammation in the lymphatic vessels, leading to chylous ascites.
- Filariasis: A parasitic infection that can cause lymphatic obstruction and chylous ascites in endemic areas.