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Szu-Chun Hung, Der-Cherng Tarng, A rare cause of oedema, Nephrology Dialysis Transplantation, Volume 19, Issue 9, September 2004, Pages 2413–2414, https://doi.org/10.1093/ndt/gfh165
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1Division of Nephrology, Taoyuan Veterans Hospital and 2Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
Case history
An 82-year-old man had progressive oedema and dyspnoea. His past medical history was notable for sick sinus syndrome, for which he had received a pacemaker 3 years earlier. A chest radiograph showed pulmonary oedema with a normal cardiac silhouette (not shown). Massive pleural effusions developed, as shown on repeat chest radiograph 2 months later (Figure 1). He had marked ascites and swelling of the scrotum and legs. Diagnostic evaluations including laboratory tests and imaging techniques had been exhausted, but the cause of his anasarca remained unclear. Much to everybody's surprise, thoracocentesis yielded a chylous effusion which was negative for cytology and cultures, raising the suspicion of a problem with the lymphatic system. Lymphoscintigraphy disclosed poor lymphatic flow in the lower extremities (Figure 2), a finding consistent with primary lymphoedema.
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