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Chylous Ascites and Portal Vein Clot on CT Scan

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  • Chylous Ascites and Portal Vein Clot on CT Scan

    Hi all,

    Following up on my last post. (9/1/17 Robotic RPLND w/ Seminoma found, deciding between 2XBEP and surveillance). I requested that I have pelvis, abdominal and chest CT. This was done yesterday at 5PM. At about 7PM the oncology radiologist had left 2 messages on my phone (thinking the worst) I called him back to find their was fluid in my abdomen and a clot on the portal vein near the liver (no evidence of any lymphadenopathy or any other suspicious spots).

    I went in to get checked out, after a long night in the ED, I found out that I have chylous Ascites. I will now start a non fat diet - has anyone found this a true way to cure this?

    Also, some of the health care providers have said that the clot could be due to metastatic cells in the area. On the other hand, others have said this could be due to the trauma of the surgery and an impact of the ascites.

    Has anyone had a similar situation or any advice?

  • #2
    I had a chlyothorax after surgery. When we found it they drained it off and put me on a low fat diet. I had to get it drained a second time and then it stopped. The alternative is surgery, at least it was for me, so it was a no brainier to try it. I recall getting some sort of supplemental oil to eat, I can look it up if you're curious.
    Aug 2013: vague fevers, exhaustion, weight loss, night sweats
    September 2013: became a father
    October 2013: diagnosis PMNSGCT, ~5cm x 5cm, AFP: 43 bHCG: 0
    December 2013: cycle 1, VIP 3wks
    January 2014: cycle 2, VIP 3wks, became allergic to polysorbates
    February 2014: AFP 813, bHCG: 0, scrapped chemo
    February 2014: resection, upper left lobectomy, 7 x 6 x 5 cm tumor, teratoma / adenocarcinoma
    March 2014: AFP 70
    March 2014: AFP 19
    April 2014: AFP 11 !
    <fast forward>
    September 2014: surveillance, AFP < 12 for almost 4 years

    Comment


    • #3
      Ugh! Can't chime in on the Chylous Ascities, since it was not a comp;ication my son had, so sorry. I can chime in on the blood clot near port, very common with port. My son had several during his treatment. I'm not a Dr., but Blood Thinners are usually injected or taken to rectify. Please update us when you are able.
      17 year old son Grant dx 12/21/16
      pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
      pre/o CT Scan 12/22/16 normal
      r/o 12/22/16
      Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
      PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

      -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
      2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
      BEP x 3 1/27/17
      Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
      2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
      Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

      Comment


      • #4
        Trgeka: the clot was on the portal vein rather than a port.
        Aug 2013: vague fevers, exhaustion, weight loss, night sweats
        September 2013: became a father
        October 2013: diagnosis PMNSGCT, ~5cm x 5cm, AFP: 43 bHCG: 0
        December 2013: cycle 1, VIP 3wks
        January 2014: cycle 2, VIP 3wks, became allergic to polysorbates
        February 2014: AFP 813, bHCG: 0, scrapped chemo
        February 2014: resection, upper left lobectomy, 7 x 6 x 5 cm tumor, teratoma / adenocarcinoma
        March 2014: AFP 70
        March 2014: AFP 19
        April 2014: AFP 11 !
        <fast forward>
        September 2014: surveillance, AFP < 12 for almost 4 years

        Comment


        • #5
          I had a lymphocelle after my RPLND. It showed up in my first CT after as like 5cm, right where one of my lymph nodes was removed. A repeat scan a few months later showed it significantly smaller, and then the scan after that it had gone away. My lymphocele was fully contained though, it didn't continuously leak inside me, it must have just collected in one spot until I healed enough, then slowly my body re-absorbed it. Dr. Foster said they are not uncommon, he sees them after RPLND in some cases.
          6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
          6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
          7/7/15: bHCG 56, AFP 42, LDH 322
          7/13/15 - 9/18/15: 4xEP
          10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
          10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
          4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
          4/20/16: RPLND @ IU - teratoma only!
          9/18/2017 all clears up to this date!

          Comment


          • #6
            oops, big difference between portal vein and port. Could it be linked to your leakage issues?
            17 year old son Grant dx 12/21/16
            pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
            pre/o CT Scan 12/22/16 normal
            r/o 12/22/16
            Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
            PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

            -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
            2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
            BEP x 3 1/27/17
            Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
            2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
            Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.

            Comment


            • #7
              Phan11 I am sorry to hear about the chylous. That complication plain out sux. i had a PC-RPLND for seminoma by Dr. foster at IU in Jan 2013. I ended with Chylous Ascites for ~8wks, i can say unequivecolly this was the worst 8 weeks of my life. i was being drained of ~7liters every 2weeks by abdominal paracentecis, probably would have felt better if I went every week, but the procedure is also not fun - so you find a tolerable balance. I did the no fat diet with supplemented medium chain triglecyride oil for the 8 weeks without fluid fluctuation I lost 40lbs during this time. I was at consult for parenteral feeding line when I stopped gaining weight for 3 days straight and things resolved. In hind sight I got very little advice on nutrition - seek out a nutritionist ! weigh yourself each day same time preferable after sleeping and before drinking anything, keep a log you will no when the leak stops. i agree with others that at this early stage the radiologically visible "clot" could be trauma / healing / scarring from the surgery. on follow-up scans i had what appeared to be a mass with SUV uptake at location of Psoas muscle after ~4.5yrs surveillance this has not grown and is believed to be scar tissue from my surgery. With so much surgery and trauma I would make sure that if they do any further PET scan on you, they consider heavily the sensitivity of the PET. My local Dr. was advocating 2nd line chemo based on the mass and PET uptake. Very, happy I made the trip to IU to see Dr. E again and did not have to go that route. Best wishes. Ross

              Comment


              • #8
                "medium chain triglecyride oil" Yep, that's the stuff I was put on as well. Couldn't stand it, but in the end it worked along with diet mods.
                Aug 2013: vague fevers, exhaustion, weight loss, night sweats
                September 2013: became a father
                October 2013: diagnosis PMNSGCT, ~5cm x 5cm, AFP: 43 bHCG: 0
                December 2013: cycle 1, VIP 3wks
                January 2014: cycle 2, VIP 3wks, became allergic to polysorbates
                February 2014: AFP 813, bHCG: 0, scrapped chemo
                February 2014: resection, upper left lobectomy, 7 x 6 x 5 cm tumor, teratoma / adenocarcinoma
                March 2014: AFP 70
                March 2014: AFP 19
                April 2014: AFP 11 !
                <fast forward>
                September 2014: surveillance, AFP < 12 for almost 4 years

                Comment

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