Which endoscopic finding is classic for lymphatic dilation?

• A. White pinpoint to rice grain-like lesions
• B. Large necrotic ulcers
• C. Epithelial pseudomembranes
• D. Normal mucosa

Answer: (A)

Lymphatic dilation in the gut shows up endoscopically as tiny white pinpoints, often described as rice-grain–like lesions, on the mucosal surface. These white spots come from dilated lymphatic channels (lacteals) in the lamina propria that contain chyle. This finding is classic because it directly reflects the underlying dilated lymphatics rather than mucosal destruction or infection. Large necrotic ulcers point to destructive inflammatory or infectious processes, epithelial pseudomembranes indicate a pseudomembranous process, and normal-appearing mucosa wouldn’t reveal the lymphatic dilation. Understanding this link helps connect the endoscopic appearance to the pathophysiology of lymphangiectasia and its potential clinical consequences like protein-losing enteropathy.