# Chylous Ascites in a Calf: A Case Report

R.N Assis, E.H Melo, R.O Rego, L. T. Coutinho, R. J. C. Souto, J.A.B.

Afonso, C. L. Mendonça

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R.N Assis, E.H Melo, R.O Rego, L. T. Coutinho, R. J. C. Souto, et al.. Chylous Ascites in a Calf: A Case Report. Revue de Médecine Vétérinaire, 2019, 7 (170), pp.180-183. hal-04912534

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# Chylous Ascites in a Calf: A Case Report

R. N. ASSIS<fnref n="1" />*, E. H. MELO<fnref n="2" />, R. O. REGO<fnref n="1" />, L. T. COUTINHO<fnref n="3" />, R. J. C. SOUTO<fnref n="3" />, J. A. B. AFONSO<fnref n="3" />, C. L. MEN-DONÇA<fnref n="3" />

Corresponding author: reginanobregadeassis@gmail.com

## SUMMARY

Chylous ascites is a rare clinical condition, characterized by the accumulation of lymph in the peritoneal cavity with a high concentration of triglycerides. This report describes a case of chylous ascites diagnosed in a 9-month-old female mixed-breed calf with a history of abdominal distension. On admission to the hospital unit, the animal was standing with no signs of abnormal behavior. It exhibited a normal appetite but mild dehydration, and it had a normal respiratory rate, tachycardia, a bulging abdomen on both sides, and soft feces. Serum biochemical analysis revealed hypoalbuminemia. Gamma glutamyltransferase and aspartate aminotransferase serum activity, as well as concentrations of total cholesterol, high-density lipoprotein cholesterol, triglycerides, and creatinine were within normal ranges. An odorless, light yellow milky fluid of viscous consistency and cloudy appearance was obtained via abdominocentesis. Cytology revealed a predominance of small lymphocytes, and biochemical evaluation of the peritoneal fluid revealed concentrations of 3.95 mmol/L triglycerides and 5.67 mmol/L total cholesterol. The intense abdominal distension associated with pulmonary compression resulted in the death of the animal. Anatomical changes in the urinary system, including ureteral ectopia and a large volume of chylous fluid in the abdominal cavity, were found at necropsy. The high concentration of triglycerides in the peritoneal fluid was 13 times higher than the serum concentration and the anatomopathological findings confirmed a diagnosis of chylous ascites of congenital origin.

**Keywords:** Cattle, cavity effusion, cholesterol, chyloperitoneum, ascites, triglycerides

## RÉSUMÉ

### Ascites chyleuses chez un veau : Rapport de Cas

L'ascite chyleuse est une affection clinique rare, caractérisée par l'accumulation de lympe dans la cavité péritonéale avec forte concentration de triglycérides. Ce rapport décrit un cas d'ascite chyleuse diagnostiqué chez une génisse de race mixte e âgé de 9 mois, présent à l'unité hospitalière, avec des antécédents de distension abdominale. L'animal présentait en débout, sans altération du comportement, l'appétit présent, une légère déshydratation, une fréquence respiratoire normale, une tachycardie, un renflement abdominal bilatéral et des fœces de consistance ramollie. L'analyse biochimique du sérum a révélé une hypoalbuminémie, les activités sériques de gamma glutamyltransférase et de l'aspartate aminotransférase, ainsi que des concentrations de cholestérol total, de cholestérol HDL, de triglycérides et de créatinine étaient dans les limites de la normalité. Dans l'abdominocentèse, on obtient un liquide jaune pâle, l'aspect trouble, laiteux, d'une consistance visqueuse et inodore. La cytologie a montré une prédominance de petits lymphocytes. L'évaluation biochimique du liquide péritonéal révèle une concentration de 3,95 mmol / L de triglycérides et de 5,67 mmol / L de cholestérol total. À la nécropsie, nous avons trouvé des changements anatomiques du système urinaire caractérisés par une ectopie des uretères et un grand volume de liquide chyleux dans la cavité abdominale. La haute concentration de triglycérides dans le liquide péritonéal, treize fois supérieure à la concentration sérique, et les résultats anatomopathologiques confirment le diagnostic d'ascite chyleuse d'origine congénitale.

**Mots clés :** Bovins, cholestérol, épanchement cavitaire, kilopéritoine, ascytes, triglycérides.

## Introduction

Chylous ascites is a clinical condition considered rare in humans and animals, characterized by the accumulation of lymphatic fluid in the peritoneal cavity with a high concentration of triglycerides. It develops secondary to injury or obstruction of the lymphatic system due to benign or malignant causes [5, 28, 31, 32]. In dogs and cats, chylous ascites has been found to be associated with neoplasias, liver cirrhosis, cardiomyopathies, traumas, and surgical complications [11, 21, 22]. In horses, the condition has been reported in association with idiopathic intestinal lymphangiectasia, rupture of lymphatic veins and aplasia or lymphatic hypoplasia, malignancies, severe congenital malformations, and intestinal strangulation or volvulus [6, 10].

The first reported bovine case of chylous ascites was that of a calf described by Virchow in 1854 [Apud 7]. Years

later, a case of a calf with chylous ascites and chylothorax associated with traumatic injury of the thoracic duct was reported [7]. Another case of a young cow with the condition was subsequently reported [29], but its primary cause was evidently not determined. The relative scarcity of information about the occurrence of chylous ascites in cattle motivated this description of the present case, including clinical and pathological information.

## Case description

A 9-month-old female mixed-breed calf that had been raised under a semi-intensive regimen was admitted to the Cattle Clinic at the Federal Rural University of Pernambuco, Garanhuns Campus, Brazil, with a history of abdominal distension since its first month of life. According to its owner, the abdominal distension had worsened in the last 4 months. The calf had been fed ad libitum with native pasture, corn silage, concentrated ration, and mineral salt.

<footnote n="1">¹Universidade Federal Rural de Pernambuco (UAG/UFRPE), Programa de Pós-Graduação em Sanidade e Reprodução de Ruminantes, Av. Bom Pastor s/n, CP 152-Boa Vista. Garanhuns-PE, BRAZIL.</footnote>

<footnote n="2">²Universidade Federal Rural de Pernambuco (UFRPE), Programa de Pós-Graduação em Ciência Veterinária, Av. Dom Manoel de Medeiros s/n, Dois Irmãos, Recife, PE 52.171-030, BRAZIL.</footnote>

<footnote n="3">³Clinica de Bovinos de Garanhuns, UFRPE. Av. Bom Pastor s/n, Caixa postal 152-Boa Vista. Garanhuns, PE, BRAZIL.</footnote>
The animal underwent clinical examination as recommended by Dirksen et al. [8]. It was standing, with no signs of abnormal behavior. It had a normal appetite and a rectal temperature of 38.4°C, pale pink mucous membranes of the eyes, normal nutritional status, mild dehydration, a physiological respiratory rate (16 rpm), tachycardia (100 bpm), intense abdominal bulging on both sides, a rumen filled with defined laminations, physiological rumen, abomasal and intestinal peristalsis, and soft feces (Figure 1-A).

<figure><img src="image_2.png" /><figcaption>FIGURE 1: Clinical, laboratory, and anatomopathological findings in a calf with chylous ascites. (A) Caudal view of the animal showing marked abdominal distension. (B and C) Abdominocentesis and milky peritoneal fluid. (D) Ectopic tissue structure forming a pocket attached to a vesicle (apparent lumen) in the peritoneum were taken from the inguinal and ventral region of the chylous fluid).</figcaption></figure>

with a 25 x 8-mm needle in silicone tubes with 10% EDTA anticoagulant and without anticoagulant (Vacuette® FC Mix tube, Greiner Bio-One, São Paulo, Brazil) for hemogram, determination of total plasma protein, plasma fibrinogen, and collection of blood serum [13]. Commercial kits were used (Labtest Diagnóstica SA, Lagoa Santa, MG, Brazil) for measuring serum concentrations of total protein, albumin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine, and serum activity of the aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT) enzymes. A semi-automatic biochemical analyzer (Bioplus 2000, Bioplus Lab Products Ltd., Barueri/SP, Brazil) was used for analysis.

There were no changes in blood counts or plasma protein and fibrinogen concentrations (table 1). Serum biochemical analysis revealed hypoalbuminemia (21.2 g/L), hyperglobulinemia (49.8 g/L), a low A/G ratio (0.43), no changes in serum GGT activity (30.60 U/L) or AST (83.81 U/L), total protein 71 g/L, total cholesterol 2.32 mmol/L, high-density lipoprotein cholesterol 1.22 mmol/L, triglycerides 0.30 mmol/L, and creatinine 52.16 µmol/L (table 1). Peritoneal fluid was obtained via abdominocentesis as recommended by Dirksen [8] and Peek & Divers [23] with a 40 x 16-mm needle and was kept in vacutainer® silicone tubes without anticoagulant, then analyzed in accordance with Zadnik [34] and Valenciano et al. [30]. Triglycerides and total cholesterol concentrations of the peritoneal fluid were measured via the same methodology used for blood serum. The fluid resulting from abdominocentesis was odorless

<table><caption>TABLE I: Hematological, biochemical, total plasma protein, and plasma fibrinogen values of a calf affected by chylous ascites.</caption><thead><tr><th>Hematological values</th><th>Calf</th><th>Reference range*</th></tr></thead><tbody><tr><td>Hematocrit (%)</td><td>29</td><td>24-46</td></tr><tr><td>RBC (×106/µL)</td><td>7.0</td><td>5.0-10.0</td></tr><tr><td>Hemoglobin (g/dL)</td><td>9.99</td><td>8.0-15.0</td></tr><tr><td>MCV (fL)</td><td>41.43</td><td>40.0-60.0</td></tr><tr><td>MCHC (%)</td><td>34.45</td><td>30.0-36.0</td></tr><tr><td>TPP (g/dL)</td><td>7.2</td><td>7.0-8.5</td></tr><tr><td>PF (mg/dL)</td><td>600</td><td>300-700</td></tr><tr><td>WBC (/µL)</td><td>9750</td><td>4000-12000</td></tr><tr><td>Monocytes (/µL)</td><td>293</td><td>25-840</td></tr><tr><td>Lymphocytes (/µL)</td><td>7312</td><td>2500-7500</td></tr><tr><td>Eosinophils (/µL)</td><td>195</td><td>0-2400</td></tr><tr><td>Neutrophils (/µL)</td><td>1560</td><td>600-4000</td></tr><tr><td>Basophils (/µL)</td><td>194</td><td>0-200</td></tr><tr><td>Biochemical values</td><td></td><td></td></tr><tr><td>Total protein (g/dL)</td><td>71.0</td><td>67.0-74.60</td></tr><tr><td>Albumin (g/L)</td><td>21.2*</td><td>30.3-35.50</td></tr><tr><td>Globulin (g/L)</td><td>49.8*</td><td>30.0-34.8</td></tr><tr><td>A/G ratio</td><td>0.43*</td><td>0.84-0.94</td></tr><tr><td>AST (U/L)</td><td>83.81</td><td>78-132</td></tr><tr><td>GGT (U/L)</td><td>30.60</td><td>6.1-17.40</td></tr><tr><td>Cholesterol total (mmol/L)</td><td>2.32</td><td>2.07-3.11</td></tr><tr><td>HDL (mmol/L)</td><td>1.22</td><td>0.57-1.35</td></tr><tr><td>Triglycerides (mmol/L)</td><td>0.30*</td><td>0.0-0.20</td></tr><tr><td>Creatinine (µmol/L)</td><td>52.16</td><td>88.4-177</td></tr></tbody></table>
and milky, with a light-yellow color, cloudy appearance, and viscous consistency (Figure 1-B, 1-C). Cytology revealed a predominance of small lymphocytes, some vacuolated macrophages and eosinophils, and a small number of neutrophils. Biochemical evaluation of the peritoneal fluid revealed a 3.95 mmol/L concentration of triglycerides and a 5.67 mmol/L concentration of total cholesterol.

The animal died due to respiratory complications associated with marked abdominal distension and was referred for necropsy. Approximately 65 L of light-yellow milky fluid were found in the abdominal cavity. The fluid was drained from a partially ruptured, rounded ectopic tissue structure attached to the vesicle, which when punctured released a yellowish milky fluid with an aqueous consistency like that found in the abdominal cavity (Figure 1-D). The necropsy also revealed that the left ureter was dilated and had a bifurcation of which one end was directed towards the bladder and the other along with the right ureter converged directly to the vaginal conduit. The mesentery exhibited reddish edema attached to the tissue structure and bladder. Aortic and perirenal lymph nodes and those found in the serosa of the rumen and abomasum were enlarged.

## Discussion

Reports on chylous ascites affecting cattle are rare in the international literature, and no cases have been described in Brazil. The calf in the current study had marked abdominal distension similar to that described in Stöber [29], in contrast with the case described by Cruz et al. [7] of a calf with chylothorax and chylous ascites that did not have intense abdominal distension but did exhibit apathy, fever, tachycardia, tachypnea, and abdominal discomfort. The absence of blood changes observed in the present case was also observed by Cruz et al. [7], who reported no hematological or biochemical abnormalities in the affected calf. Notably, the concentrations of other biochemical parameters investigated were within the normal bovine ranges [14, 20, 24, 27]. An absence of blood changes has also been described in other species [6, 32].

The hypoalbuminemia observed was a result of protein loss to the abdominal cavity [19], as has also been reported in other species [6, 32]. The low A/G ratio was a result of the chronicity of the process [9]. The chylous fluid had a similar appearance to that described in the literature [1, 7]. The cloudy and milky characteristic of chylous fluid is due to a high number of chylomicron particles [2].

As in the present case, Cruz et al. [7] also observed a predominance of lymphocytes in calves which is characteristic of chylous ascites. According to Melzen & Sellon [19], this predominance is due to the release of lymphocytes in the abdominal cavity as a result of the rupture of lymphatic vessels. This cytological finding is characteristic of this type of effusion and has also been described in different species [6, 12, 32].

The peritoneal fluid:serum ratio of triglycerides was 13:1 in the present case, which differs from a report by Cruz et al. [7] of a ratio of greater than 50:1. Usually, in chylous ascites the triglyceride concentration is 2–8 times that of serum [6, 32]. The increase in triglycerides in the peritoneal fluid is due to the presence of chylomicrons, which are mainly composed of triglycerides and cholesterol in the lymphatic chain [2].

Primary chylous disorders are often caused by congenital lymphatic dysplasias. In this context, chylous ascites is one of the major sequelae of developmental disorders with possible involvement of dilated lymphatic vessels. Late maturation of lymphatic vessels results in the formation of abnormal structures in the vessel wall in newborn humans, leading to lymphatic invasion in the peritoneal cavity [1, 4, 25]. Cases of congenital chylous ascites affecting foals are attributed to aplasia or lymphatic hypoplasia [3, 10, 18]. Although rare, hereditary congenital lymphedema described in cattle is another congenital anomaly that affects the lymphatic system in cows [15, 26]. Therefore, it is concluded that the anatomical changes observed at necropsy, along with the great volume of chylous fluid found in the abdominal cavity, confirm the diagnosis of chylous ascites of congenital origin in the present case.

## References

1. BHARDWAJ R., VAZIRI H., GAUTAM A., BALLESTEROS E., KARIMEDDINI D., WU G.Y. Chylous ascites: A review of pathogenesis, diagnosis and treatment. *J. Clin. Transl. Hepatol.*, 2018, **6**, 105-113.

2. BRUSS M.L. Lipids and ketones. In: J.J. KANEKO, J.W. HARVEY, M.L. BRUSS. Clinical Biochemistry of Domestic Animals. New York: Academic Press, 2008, 81-116.

3. CAMPBELL-BEGGS C.L., JOHNSON P.J., WILSON D.A., MILLER M.A. Chyloabdomen in a neonatal foal. *Vet. Rec.*, 1995, **137**, 96-98.

4. CAMPISI C., BELLINI C., ERETTA C., ZILLI A., da RIN E., DAVINI D., BONIOLI E., BOCCARDO F. Diagnosis and management of primary chylous ascites. *J. Vasc. Surg.*, 2006, **43**, 1244-1248.

5. CÁRDENAS A., CHOPRA S. Chylous ascites. *Am. J. Gastroenterol.*, 2002, **97**, 1896-1900.

6. CESAR F.B., JOHNSON C.R., PANTALEON L.G. Suspected idiopathic intestinal lymphangiectasia in two foals with chylous peritoneal effusion. *Equine vet. Educ.*, 2010, **22**, 172-178.

7. CRUZ A.M., RILEY C.B., MACDONALD D.G., FERGUSON J.G. Use of mesenteric lymphangiography in a calf with chylothorax and chyloperitoneum. *J. Am. Vet. Med. Assoc.*, 1995, **206**, 1567-1571.

8. DIRKSEN G. Sistema digestivo. In: G. DIRKSEN, H.D. GRÜNDER, M. STÖBER. Rosenberger Exame Clínico dos Bovinos. 3rd ed. Rio de Janeiro: Guanabara Koogan, 1993, 166-228.

9. ECKERSALL P.D. Proteins, proteomics, and the dysproteinemias. In: J.J. KANEKO, J.W. HARVEY, M.L.
BRUSS. Clinical Biochemistry of Domestic Animals. New York: Academic Press, 2008, 117-155.

10. - FISH E.J., BOES K.M., WILSON K.E., WEINSTEIN N.M. Pathology in practice. Chylous ascites with secondary neutrophilic inflammation in a foal. *J. Am. Vet. Med. Assoc.*, 2015, **246**, 857-859.

11. - FOSSUM T.W., HAY W.H., BOOTHE H.W., ZACK P.M., SHERDING R.G., MILLER M.W. Chylous ascites in three dogs. *J. Am. Vet. Med. Assoc.*, 1992, **200**, 70-76.

12. - GOULD L. The medical management of idiopathic chylotorax in a domestic long-haired cat. *Can. Vet. J.*, 2004, **45**, 51-54.

13. - HARVEY J.W. Hematology procedures. In: _Veterinary Hematology. A Diagnostic Guide and Color Atlas_. St. Louis: Elsevier, 2012, 11-32.

14. - HOFFMANN W. E., SOLTER, P.F. Diagnostic enzymology of domestic animals. In: J.J. KANEKO, J.W. HARVEY, M.L. BRUSS. Clinical Biochemistry of Domestic Animals. New York: Academic Press, 2008, 351-378.

15. - JAIN N.C.: Essentials of Veterinary Hematology. 1th ed. 417 pages. *Lea & Febiger. Philadelphia*. 1993.

16. - KANEKO J.J., HARVEY L.W., BRUSS M.L. Clinical Biochemistry of Domestic Animals. 6th ed, 916 pages, *Academic Press, New York*, 2008.

17. - MACÊDO J.T.S.A., LUCENA R.B., TOCHETTO C., OLIVEIRA FILHO J.C., PIEREZAN F., IRIGOYEN L.F., BARROS C.S.L. Primary congenital lymphedema in Red Angus Cattle. *Braz. J. Vet. Res.*, 2009, **29**, 713-718.

18. - MAIR T.S., LUCK V.M. Chyloperitoneum associated with torsion of the large colon in a horse. *Vet. Rec.*, 1992, **131**, 421.

19. - MELZER K.J., SELLON, R.K. Canine intestinal lymphangiectasia. *Comp. Cont. Educ. Pract. Vet.*, 2002, **24**, 953-960.

20. - MORAES, D.V. Perfil bioquímico sérico de bezerros mestiços durante o primeiro ano de vida. 2011.32f. Dissertação (Mestrado no Programa de Pós Graduação em Ciências Veterinárias) Universidade Federal de Uberlândia (Abstract in English).

21. - MYERS N.C. 3rd, ENGLER S.J., JAKOWSKI R.M. Chylothorax and chylous ascites in a dog with mediastinal lymphangiosarcoma. *J. Am. Anim. Hosp. Assoc.*, 1966, **32**, 263-269.

22. - NELSON K.L. Chyloabdomen in a mature cat. *Can. Vet. J.*, 2001, **42**, 381-383.

23. - PEEK S.F., DIVERS T.J. Rebhun's Diseases of Dairy Cattle. St. Louis: Saunders, 2018, 704.

24. - POGLIANI F.C., BIRGEL JÚNIOR E.H. Reference values of the lipidogram of bovines of the Dutch breed, raised in the State of São Paulo. *Braz. J. Vet. Res. Anim. Sci.*, 2007, **44**, 373-383.

25. - ROMÁNSKA-KITA J., BORSZEWSKA-KORNACKA M.K., DOBRZÁNSKA A., RUDZÍNSKA I., CZECH-KOWALSKA J., WAWRZONIAK T. Congenital chylous ascites. *Pol. J. Radiol.*, 2011, **76**, 58-61.

26. - SCHILD A.L., RIET-CORREA F., MENDEZ M.C. Hereditary lymphedema in Hereford cattle. *J. Vet. Diagn. Invest.*, 1991, **3**, 47-51.

27. - SOUZA R.M., BIRGEL Jr E.H., AYRES M.C.C., BIRGEL E.H. Influence of racial factors on liver function of Holstein and Jersey cattle. *Braz. J.Vet. Res. Anim. Sci.*, 2004, **41**, 306-312.

28. - STEINEMANN D.C., DINDO D., CLAVIEN P.A., NOCITO A. Atraumatic chylous ascites: systematic review on symptoms and causes. *J. Am. Coll. surg.*, 2011, **212**, 899-905.

29. - STÖBER, M. Enfermedades del sistema linfático y del bazo. In: G. Dirksen, H.D. Gründer, M. Stöber. Medicina interna y cirugía del bovino. Buenos Aires, Inter-médica, 2005, 123-145.

30. - VALENCIANO A.C., ARNDT T.P., RIZZI, T.E. Effusions: Abdominal, thoracic, and pericardial. In: A.C. VALENCIANO, R.L. COWELL. Diagnostic and Hematology of the Dog and Cat. St. Louis: Elsevier, 2014, 244-265.

31. - VETTORETTO N., ODEH M., ROMESSIS M., PETTINATO G., TAGLIETTI L., GIOVANETTI M. Acute abdomen from chylous peritonitis: a surgical diagnosis Case report and literature review. *Eur. Surg. Res.*, 2008, **41**, 54-57.

32. - VILALTA L., ALTUZARRA R., MOLINA J., MELÉNDEZ-LAZO A., DORIA G., ESPADA Y., RAMIS A., MARTORELL J. Chylous ascitess in 2 ferrets. *J. Exot. Pet Med.*, 2017, **26**, 150-155.

33. - VIRCHOW, R. Ueber makroglossie und pathologische neubildung quergestriefter muskelgfasern. *Arch. Pathol. Anat.*, 1854, 7, 126-138.

34. - ZADNIK T.A Retrospective study of peritoneal fluids in cows with abdominal disorders. *Vet. Glasnik.*, 2010, **64**, 187-195.