Varón de 60 años que debuta con ascitis quilosa

espanolVaron de 60 anos que acude a Urgencias por aumento progresivo del diametro abdominal y edematizacion de miembros inferiores de un mes de evolucion. En la exploracion fisica, distension abdominal con signos de ascitis a tension. Se realiza paracentesis extrayendo 7 L de aspecto lechoso cuyo analisis revela niveles de trigliceridos >1000 mg/dl. En TC toracoabdominal se observan adenopatias axilares bilaterales, abdominales intra y retroperitoneales de hasta 4 cm, e inguinales bilaterales. Conglomerado adenopatico en region mesenterica de 19x14x9 cm. Exeresis en quirofano de adenopatia inguinal derecha cuyo analisis es compatible con Linfoma B folicular Grado 2 (OMS 2017). El paciente recibe dieta rica en proteinas y exenta de grasas y tras 6 ciclos de tratamiento con R-CHOP, se realiza PET-TC que informa de respuesta metabolica completa al tratamiento. La ascitis quilosa es una rara entidad que consiste en el acumulo de linfa en la cavidad abdominal. El liquido ascitico es lechoso debido a la alta concentracion de trigliceridos (>200 mg/dl). Supone menos del 1% de los casos de ascitis. Esta causada por la disrupcion traumatica u obstructiva del sistema linfatico que produce una extravasacion de linfa al espacio abdominal, acumulandose un fluido lechoso rico en trigliceridos. En adultos, es importante descartar el origen maligno de la ascitis, en orden de prevalencia: linfomas, tumores neuroendocrinos, sarcomas y leucemias. El tratamiento y el pronostico dependen de la causa subyacente. EnglishA 60 years old man went to the Emergency Department due to a progressive increase in the abdominal diameter and swelling of the lower limbs of one month of evolution. In the physical examination, abdominal distension with signs of ascites to tension. Paracentesis is performed with extraction of 7L of milky aspect whose analysis reveals levels of triglycerides >1000 mg/dl. Thoracoabdominal CT showed bilateral axillary, intra and retroperitoneal abdominal adenopathies up to 4 cm, and bilateral inguinal lymph nodes. Adenopathic conglomerate in the mesenteric region of 19x14x9 cm. Exeresis is scheduled in the operating room of the right inguinal adenopathy whose analysis is compatible with Follicular B Lymphoma Grade 2 (WHO 2017). The patient receives a rich in proteins and free of fats diet and it is performed a PET-CT after 6 cycles of treatment with R-CHOP, which reports a complete metabolic response to treatment. Chylous ascites is a rare entity that consists of the accumulation of lymph in the abdominal cavity. The ascitic fluid is a milky one due to the high concentration of triglycerides (> 200 mg/dl). It accounts for less than 1% of ascites cases. It is caused by the traumatic or obstructive disruption of the lymphatic system that produces an extravasation of lymph into the abdominal space, accumulating a milky fluid rich in triglycerides. In adults, it is important to rule out the malignant origin of ascites, in order of prevalence: lymphomas, neuroendocrine tumors, sarcomas and leukemias. Treatment and prognosis depend on the underlying cause.