Learning objectives
To define the causes of thoracic and abdominal lymphatic leaks.
To illustrate the role of intranodal lymphography as a diagnostic and therapeutic tool in lymphatic leaks,
including chylous ascites and chylothorax.
Background
Chylous leaks are uncommon conditions resulting from leakage of intestinal lymph (chyle) outside the lymphatic system.
The cause can be either traumatic or nontraumatic.
Lymphatic leakage can induce local complications,
such as infections or delayed wound healing,
or cause severe malnutrition.
Treatment has traditionally consisted with a combination of low fat enteral nutrition and somatostatin analogs,
and/or surgery.
Lymphangiography(LG) is a valuable tool for the detection of various types of lymphatic leakage including chylothorax and chylous ascites.
Besides the diagnostic role of identifying the lymphatic...
Findings and procedure details
Chylous leaks can occur anywhere along the pathway of chyle that begins in the intestinal lymphatic ducts and continue through the cisterna chyli (CC) and into the thoracic duct (TD).
These leaks result in a diversity of clinical presentations such as chylothorax and chylous ascites,
and can induce local complications,
or cause severe malnutrition.
A chylothorax occurs when lymph fluid from the thoracic duct or its tributaries accumulates in the pleural space.
The etiologies of chylothorax can be categorized astraumatic or nontraumatic (Table 1,
2)....
Conclusion
Lymphangiography in conjunction with thoracic duct embolization is a relatively safe,
powerful,
and reliable interventional method.
It enables identification of lymphatic leakage and provides complete occlusion,
which results in complete resolution of one of the most devastating complications of thoraco-abdominal surgery.
Due to its minimally invasive nature and its proven effectiveness,
the need for reoperation and exposure to perioperative morbidity may be avoided.
References
Chen,
E.
and Itkin,
M.
(2011).
Thoracic Duct Embolization for Chylous Leaks.
Seminars in Interventional Radiology,
28(01),
pp.063-074.
Lee,
E.,
Shin,
J.,
Ko,
H.,
Park,
J.,
Kim,
S.
and Sung,
K.
(2014).
Lymphangiography to Treat Postoperative Lymphatic Leakage: A Technical Review.
Korean Journal of Radiology,
15(6),
p.724.
Dinc,
H.,
Oguz,
S.
and Sari,
A.
(2015).
A novel technique in the treatment of retroperitoneal lymphatic leakage: direct percutaneous embolization through the leakage pouch.
Diagnostic and Interventional Radiology,
21(5),
pp.419-422.
Liu,
J.,
Sato,
Y.,
Motoyama,
S.,
Ishiyama,...