When Appearance Is Everything: Chylous Ascites Vipul Nayi, MD, MS, Yanhua Wang, MD, PhD, Benjamin Galen, MD  The American Journal of Medicine  Volume 131, Issue 11, Pages 1314-1316 (November 2018) DOI: 10.1016/j.amjmed.2018.06.011 Copyright © 2018 Terms and Conditions

Figure 1 Cloudy, amber, ascitic fluid had a triglyceride level of 375 mg/dL. A level >200 mg/dL is consistent with chylous ascites.1 The American Journal of Medicine 2018 131, 1314-1316DOI: (10.1016/j.amjmed.2018.06.011) Copyright © 2018 Terms and Conditions

Figure 2 This is a contour plot of flow cytometry results from a sample of the patient's ascitic fluid. (A) Side scatter vs forward scatter. Atypical B cells, in yellow, are larger with a higher forward scatter. T cells are denoted in green. Neutrophils are in red with high side scatter. (B) Side scatter vs CD45 cells (labeled with AmCyan). Both T cells and atypical B cells are CD45 positive, but the atypical B cells are slightly dim in CD45 expression compared with that of normal T cells. (C-F) The atypical B cells are positive for CD19 (labeled with PE-Cy7) and CD20 (not shown) but negative for CD5 (labeled with Pacific blue), CD10 (labeled with perCP-Cy5.5), and CD23 (not shown). (G) The atypical B cells are negative to dimly positive for kappa light chains (labeled with FITC) but negative for lambda light chains (labeled with PE). These findings were compatible with a CD5-/CD10- mature B-cell lymphoma. The American Journal of Medicine 2018 131, 1314-1316DOI: (10.1016/j.amjmed.2018.06.011) Copyright © 2018 Terms and Conditions

Figure 3 Computed tomography without intravenous contrast of the patient's abdomen showed a large para-aortic mass with a confluence of lymph nodes at the white arrows in transverse (A) and coronal (B) views. The American Journal of Medicine 2018 131, 1314-1316DOI: (10.1016/j.amjmed.2018.06.011) Copyright © 2018 Terms and Conditions