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Type:
Educational Exhibit
Keywords:
Fistula, Embolisation, Contrast agent-other, Complications, MR, Lymphography, CT, Lymph nodes, Interventional non-vascular, Abdomen
Authors:
A. Witteler, N. Acar, A. M. Ranft, J. Altenbernd, T. Schwenzer, S. Rohde; Dortmund/DE
DOI:
10.1594/ecr2015/C-1442
Background
Due to the small size of lymph vessels the detection of a lymph fistula is challenging.
Some fistulas can be detected by lymphography and lymph scintigraphy.
The intraoperative injection of methylene blue into lymph vessels can show the leak of a lymph vessel.
There is no consensus on the management of chyle leaks (6) and the low number of patients results in the lack of prospective therapy studies.
Non invasive treatment with bowel rest,
parenteral nutrition and pharmacological therapies etc.
will not stop a lymph fistula immediately in most cases,
although Zhao et al.
(1) stated that in their study of 9 patients the chylous ascites resolved in all patients within a maximum of 9 days by treating the patients conservatively with an abdominal drainage tube.
There are some reports about the occlusion of lymph fistulas as an effect of pedal lymphography,
e.
g.
Gruber-Rouh et al.
(2) described a successful treatment rate of 70.3% by performing a diagnostic lymphography with a higher success rate (96.8%) in patients with an ascites production of less than 200 ml per day whereas the efficiency was less if there was an ascites production of more than 200 ml (58.1%).
Post lymphangio-CT can increase the diagnostic accuracy of lymphography (5).
If the localisation of the lymph fistula can be detected,
surgical or interventional therapy can be an option to occlude the fistula immediately especially in patients with a persisting fistula after conservative therapy (3).
Surgical therapy is reported to be highly efficient (2).
There are only very few reports on the treatment of chylous ascites by interventional embolisation of lymph vessels,
e.
g.
computed tomography guided injection of N-butyl cyanoacrylate glue (4).
A case report by Itou et al.
(7) showed the succesful therapy by embolisation of the extralymphatic leakage site by metallic coils and an N-butyl cyanoacrylate-ethiodized oil mixture.