It has been pointed out that in protein-losing gastroenteropathy there is often generalized anomalies of the entire lymphatic systems of the body (Pomerantz, M. & Waldmann, T.A., 1963). The authors have recently experienced a typical case of primary protein-losing gastroenteropathy in which very interesting lymphographical findings were observed. The mechanism of development of this disease is discussed in the light of these lymphographical abnormalities.
1) Thoracic ductogram: Two thoracic ducts were visualized with marked tortuosity and partial sinusoidal dilatation, indicating the presence of obstruction at the inflow site of the thoracic ducts in the vein and their consequent backward saccular dilatation.
2) Retroperitoneal lymphogram: The characteristic abnormalities included marked dilatation of the citernal chyli, obstruction at the beginning of the thoracic duct next to the cisterna chyli, marked dilatation of the retroperitoneal lymphatic vessels with many fine, tortuous lymphatic nets and retrograde lymphography, suggestive of communication with the intestinal lymphatic vessels. The lymph nodes were poorly outlined, of grossly punctate internal structure or moth-eaten. These findings were consistent with wide-spread hypoplasia or destruction of the lymph nodes.
3) Lymphography of the lower extremities: The left side is almost normal. The right side showed obstruction at the inguinal region with marked dilatation, increase and tortuosity of the peripheral lymphatic vessels and formation of the collateral lymphatics as well as dermal backflow.
On the basis of these findings, it is stressed that abnormalities of the entire lymphatic systems play an important role in the development of the protein-losing gastroenteropathy.
