Ascites (Chylous Ascites)

What is ascites?

Ascites is a buildup of fluid in the abdomen. When it’s severe, ascites can cause stomach swelling (distention), abdominal pain, and difficulty breathing and eating.

There are several kinds of ascites. Two common forms are caused by liver cirrhosis (liver disease), or certain cancers of the abdomen. When the buildup of fluid contains chyle (a milky fluid that’s a combination of lymphatic fluid and fat), this form of ascites is known as chylous ascites and is a lymphatic flow disorder.

Lymph vessels carry lymph fluid to veins, where it returns to the bloodstream, playing a crucial role in immune function and fat and protein transport. Injury to lymphatic vessels, congenital abnormalities or excessively high venous pressures can result in lymphatic flow problems and leakage of lymphatic fluid into the chest, abdomen or other body cavities.

Causes

Ascites can have many potential causes, including:

  • Injuries to the central lymphatic system due to surgery or trauma (this is also known as traumatic chylous ascites)
  • Congenital lymphatic malformations such as lymphangiomatosis
  • Tumors
  • Systemic diseases or infections such as tuberculosis
  • Congenital syndromes such as Gorham-Stout, Noonan and Turner syndromes
  • Elevated venous pressures due to heart failure, pulmonary hypertension or congenital heart surgery

Signs and symptoms

Initially, ascites causes few symptoms. When enough fluid accumulates, though, affected individuals will have either painless abdominal swelling or stomach pain.

Sometimes, fluid from the abdomen can travel through openings in the diaphragm and lead to accumulation of fluid in the chest. When this happens, it can cause breathing difficulties.

Diagnosis

Doctors use a combination of imaging tests to diagnose ascites. Tests may include X-ray, CT, ultrasound or MRI. A diagnosis of ascites is made when these tests demonstrate the presence of fluid in the peritoneal spaces.

Your doctor may also use a thin needle to withdraw some of the accumulated fluid. The fluid can then be tested to determine whether it originated in the lymphatic system.

Additionally, lymphatic imaging techniques, such as intranodal lymphangiography and dynamic contrast magnetic resonance lymphangiography, might be used to determine the exact source of the fluid.

Treatment

Treatment of ascites depends on its cause. At the Center for Lymphatic Imaging and Interventions at The Children’s Hospital of Philadelphia (CHOP) and The Hospital of the University of Pennsylvania (HUP), patients are treated by a team of experts who specialize in lymphatic imaging and interventions. The team will determine the best treatment approach for each patient’s condition.

When lymphatic imaging is able to identify the source of the leak that is causing ascites, the source can be sealed during an embolization procedure.

Long-term outlook

The long-term outlook for patients with ascites varies. Many patients who have chylous ascites caused by trauma to the central lymphatic system can be cured.

Treating patients whose ascites is caused by conditions such as liver disease and heart failure, though, can be more challenging. However, experts at the Lymphatic Center are currently developing new imaging and treatment options for these patients.

Follow-up care

Most of the follow-up care will be provided by your or your child’s primary physician in coordination with the team at the Center for Lymphatic Imaging and Interventions. This can include recommendations for new medications, medication weans or diet recommendations.

Research

Experts from CHOP and The Hospital of the University of Pennsylvania are collaborating on research to better understand the lymphatic system, develop new lymphatic interventional procedures, and to improve lymphatic imaging modalities.

Why choose us

Our team has one of the largest experiences in the world in treating both children and adults with ascites. We have developed a variety of innovative imaging and interventional techniques that have advanced the minimally invasive treatment options available to patients.