Image: This woman, who was born and lived for a number of years in Guyana, described having milky to creamy urine for weeks at a time, intermittently over the past many years.At times there would be some discomfort on passing urine and she would pass a milky jelly. The clear urine on the right is from a normal individual. What is the diagnosis?

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Image: The urine supernatant did not clear when centrifuged, but cleared several hours after being mixed with an equal amount of ether, suggesting a lipid etiology. She never had periferal edema. A lymphangiogram revealed multiple dilated lymphatic channels with tortuous collaterals. A pyelogram produced by the lymphangiogram dye indicates an anastamosis between the para-aortic and the renal lymphatic systems and explains the chyluria. In Guyana Wuchereria bancrofti is the cause of lymphangitis and post-lymphangitic scarring and obstruction.  (see lymphangiogram)