Ultrasound-guided intranodal lymphangiography followed by thoracic duct embolization for treatment of postoperative bilateral chylothorax

Head Neck. 2014 Feb;36(2):E21-4. doi: 10.1002/hed.23425. Epub 2013 Oct 19.

Abstract

Background: Percutaneous thoracic duct embolization (TDE) is a safe, effective, and minimally invasive option for treating chylothorax. A recent report demonstrated the feasibility of ultrasound-guided intranodal lymphangiography as an alternative to pedal lymphangiography for visualization of the thoracic duct, promising relative technical ease and decreased procedure time for TDE.

Methods: We report a case of postoperative bilateral chylothorax treated with ultrasound-guided intranodal lymphangiography followed by TDE.

Results: Intranodal lymphangiography resulted in rapid opacification of the abdominal lymphatics, permitting technically successful primary and secondary embolization procedures. Deployment of metallic coils and liquid embolic agents within the thoracic duct produced rapid clinical and radiographic improvement.

Conclusion: Intranodal lymphangiography is a reliable, reproducible, and less technically challenging alternative to pedal lymphangiography.

Keywords: chylothorax; embolization; intranodal; lymphangiography; thoracic duct embolization.

Publication types

  • Case Reports

MeSH terms

  • Carcinoma, Squamous Cell / surgery
  • Chylothorax / diagnostic imaging
  • Chylothorax / etiology*
  • Chylothorax / therapy*
  • Embolization, Therapeutic* / methods
  • Humans
  • Laryngeal Neoplasms / surgery
  • Lymphography*
  • Male
  • Middle Aged
  • Neck Dissection / adverse effects*
  • Pleural Effusion / etiology
  • Pulmonary Atelectasis / complications
  • Pulmonary Atelectasis / diagnostic imaging
  • Pulmonary Atelectasis / etiology
  • Reproducibility of Results
  • Risk Factors
  • Treatment Outcome
  • Ultrasonography, Interventional* / methods