1
|
Henkel A, Pieper CC. [Imaging of the lymphatic vascular system-techniques]. RADIOLOGIE (HEIDELBERG, GERMANY) 2025; 65:307-315. [PMID: 40185972 DOI: 10.1007/s00117-025-01440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2025] [Indexed: 04/07/2025]
Abstract
CLINICAL/METHODICAL ISSUE Imaging of the lymphatic vascular system is comparatively difficult and logistically demanding. STANDARD RADIOLOGICAL METHODS The field has developed significantly in recent decades. The longest established techniques are conventional X‑ray lymphangiography and lymphoscintigraphy. METHODOLOGICAL INNOVATIONS In recent years, magnetic resonance (MR) and computed tomography (CT) lymphangiography have been developed using different contrast medium (CM) techniques. For interstitial lymphangiography, CM is injected intracutaneously, and absorbed and drained by the lymphatic system. For direct techniques, CM is injected directly into a lymph node or a prepared lymph vessel. PERFORMANCE Lymphangiography procedures offer high anatomical and/or temporal resolution that have method-related differences. They allow better morphological assessment of the lymph vessels compared to lymphoscintigraphy. Furthermore, MR and CT lymphangiography are less invasive than conventional x‑ray lymphangiography. EVALUATION MR lymphangiography in particular allows dynamic assessment of lymph flow through repetitive imaging, which is particularly valuable in complex situations. While MR lymphangiography is now established in centers despite the off-label use of CM, data regarding CT lymphangiography is still very limited. PRACTICAL RECOMMENDATIONS A number of specific lymphatic imaging techniques are available at specialized centers.
Collapse
Affiliation(s)
- A Henkel
- Sektion für minimal invasive Lymphgefäßtherapie, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Claus C Pieper
- Sektion für minimal invasive Lymphgefäßtherapie, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| |
Collapse
|
2
|
Kariya S, Nakatani M, Ono Y, Maruyama T, Tanaka Y, Komemushi A, Tanigawa N. Nodal Lymphangiography and Embolization for Postoperative Lymphatic Leakage. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2025; 10:e20240012. [PMID: 40384909 PMCID: PMC12078084 DOI: 10.22575/interventionalradiology.2024-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/03/2024] [Indexed: 05/20/2025]
Abstract
Intranodal lymphangiography has replaced conventional pedal lymphangiography and has advanced lymphatic intervention. In this method, a lymph node is punctured and Lipiodol is injected to visualize the subsequent lymphatic vessels. This has facilitated the widespread adoption of lymphatic interventional radiology due to the simplicity of the technique and the shortened examination time of the procedure, which allows easy mapping of lymphatic vessels and lymphatic fluid dynamics. With this technique, lymphatic embolization was achieved by injecting an embolic substance into the lymph nodes upstream of the lymphatic leak. Although complications associated with lymphangiography are rare, caution should be exercised due to potential complications associated with the use of Lipiodol. This study summarizes intranodal lymphangiography techniques, complications, and lymphatic embolization.
Collapse
Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, Japan
| | | | - Yasuyuki Ono
- Department of Radiology, Kansai Medical University, Japan
| | | | - Yuki Tanaka
- Department of Radiology, Kansai Medical University, Japan
| | | | | |
Collapse
|
3
|
Baş A, Üstündağ A, Özdemir M, Ergün S, Samancı C, Şimşek O, Tutar O. Efficiency of intranodal lymphangiography in the treatment of postoperative lymphatic leakage. ULUS TRAVMA ACIL CER 2025; 31:221-225. [PMID: 40052319 PMCID: PMC11894238 DOI: 10.14744/tjtes.2024.79444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 09/24/2024] [Accepted: 11/10/2024] [Indexed: 03/14/2025]
Abstract
BACKGROUND This study aimed to evaluate the safety and efficacy of intranodal lymphangiography (IL) for the treatment of postoperative chyle leakage (CL), chylothorax, and chylous ascites. METHODS Between April 2018 and July 2022, eight patients who underwent IL for CL following thyroid and thoraco-abdominal surgeries were included in this retrospective study. Among these eight patients, six underwent bilateral total thyroidectomy, one underwent lobectomy of the lung, and one underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Prior to the procedure, thoracic duct ligation was attempted in one patient. Lymphangiographic findings, technical and clinical success rates, and complications were analyzed. Technical success was defined as the successful ultrasound-guided puncture of an inguinal lymph node and the opacification of the lymphatic system in the pelvis and abdomen by fluoroscopy. Clinical success was defined as a progressively decreasing drain output, culminating in the cessation of output within one week after the procedure. RESULTS Technical and clinical success was achieved in all patients. On lymphangiography, ethiodized oil leakage near the surgical bed was identified in seven of the eight patients. The median time from the procedure to drain removal was three days (range: 1-6 days) for patients who underwent surgical drainage. No recurrence of CL, chylothorax, or chylous ascites was observed during the follow-up period (range: 21-73 months; median: 38 months). CONCLUSION Intranodal lymphangiography appears to be a safe and effective minimally invasive treatment option for CL following thyroid and thoraco-abdominal surgeries, demonstrating acceptable technical and clinical success rates.
Collapse
Affiliation(s)
- Ahmet Baş
- Department of Radiology, İstanbul University-Cerrahpaşa, Faculty of Medicine, İstanbul,-Türkiye
| | - Ahmet Üstündağ
- Department of Radiology, İstanbul University-Cerrahpaşa, Faculty of Medicine, İstanbul,-Türkiye
| | - Muhammet Özdemir
- Department of Radiology, İstanbul University-Cerrahpaşa, Faculty of Medicine, İstanbul,-Türkiye
| | - Sefa Ergün
- Department of General Surgery, İstanbul University-Cerrahpaşa, Faculty of Medicine, İstanbul-Türkiye
| | - Cesur Samancı
- Department of Radiology, İstanbul University-Cerrahpaşa, Faculty of Medicine, İstanbul,-Türkiye
| | - Osman Şimşek
- Department of General Surgery, İstanbul University-Cerrahpaşa, Faculty of Medicine, İstanbul-Türkiye
| | - Onur Tutar
- Department of Radiology, İstanbul University-Cerrahpaşa, Faculty of Medicine, İstanbul,-Türkiye
| |
Collapse
|
4
|
Tuan NA, Hien NX, Trinh ND, Van Khanh L, Ly DV, Thinh NH, Anh NP, Cuong NN. Generalized lymphangiomatosis in patients treated for chylothorax following thoracoscopic sympathectomy: Case report. Radiol Case Rep 2024; 19:4725-4729. [PMID: 39228954 PMCID: PMC11366932 DOI: 10.1016/j.radcr.2024.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 09/05/2024] Open
Abstract
Generalized lymphangiomatosis (GLA) is a very rare condition in adults, characterized by diffused proliferation of lymphatic vessels that requires differential diagnosis from other vascular disorders such as cavernous or capillary hemangioma. This is because of overlapping characteristics on histopathological examination. Therefore, imaging features such as CT and MRI are useful to evaluate morphological characteristics, location, and the extent of the spread as well as differential diagnosis with other pathologies. We report a case of a 22-year-old female patient with left hemothorax after thoracoscopic sympathectomy for the treatment of hand sweating. The patient underwent drainage and cleaning of the left pleura. Chest computed tomography and lumbar spine magnetic resonance imaging showed multiple fat infiltration foci of the lumbar spine and pelvis. A wing bone biopsy of the pelvis was initially performed for the diagnosis of chronic osteomyelitis. Afterwards, the patient continued to have pleural drainage and developed hemothorax and chylothorax, amounting to 3000 mL. The chest tube was blocked with a mixture of biological glue and lipiodol (2 mL of glue, ratio of glue to lipiodol: 1:4) and a 3 i-ED coil complex. After the intervention, the pleural fluid decreased; the left pleural fluid was still 15 mm thick, and the amount of fluid drained after 1 week was 100 mL. Aspiration of the chest wall lesion showed fluid rich in fat droplets. Combined with the results of lumbar spine magnetic resonance imaging and the old biopsy, this was consistent with generalized lymphangiomatosis.
Collapse
Affiliation(s)
- Nguyen Anh Tuan
- Department of imaging and interventional radiology, Tam Anh hospital, Hanoi, Vietnam
| | - Nguyen Xuan Hien
- Department of imaging and interventional radiology, Tam Anh hospital, Hanoi, Vietnam
| | - Nguyen Duy Trinh
- Department of imaging and interventional radiology, Tam Anh hospital, Hanoi, Vietnam
| | - Le Van Khanh
- Department of imaging and interventional radiology, Tam Anh hospital, Hanoi, Vietnam
| | - Dao Văn Ly
- Department of imaging and interventional radiology, Tam Anh hospital, Hanoi, Vietnam
| | - Nguyen Hoang Thinh
- Department of imaging and interventional radiology, Tam Anh hospital, Hanoi, Vietnam
| | - Nguyen Phuong Anh
- Department of imaging and interventional radiology, Tam Anh hospital, Hanoi, Vietnam
| | - Nguyen Ngoc Cuong
- Department of imaging and interventional radiology, Ha Noi medical university hospital, Hanoi, Vietnam
| |
Collapse
|
5
|
Morino K, Morimura Y, Tanaka H, Machimoto T, Nakagawa T. Refractory Chylous Ascites Leading to Chylothorax Following Extended Right Hepatectomy for Intrahepatic Cholangiocarcinoma. Cureus 2024; 16:e73301. [PMID: 39655122 PMCID: PMC11625965 DOI: 10.7759/cureus.73301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2024] [Indexed: 12/12/2024] Open
Abstract
Chylous ascites, a rare but severe complication of abdominal surgery, often results from lymphatic vessel damage during procedures, such as extended resection and lymphadenectomy. Although conservative management through dietary modifications and medications is the primary approach, refractory cases may lead to severe complications including nutritional deficiencies and even death. Herein, we report a case of refractory chylous ascites that progressed to chylothorax after extended right hepatectomy with lymph node dissection for intrahepatic cholangiocarcinoma. A 73-year-old woman developed chylous ascites one month postoperatively, which subsequently perforated the diaphragm and led to a massive chylothorax. Despite conservative management including fasting and drainage, surgical intervention was required to resolve the condition. This case highlights the importance of timely recognition and treatment of refractory chylous ascites after extensive liver resection.
Collapse
Affiliation(s)
- Koshiro Morino
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, JPN
| | - Yuki Morimura
- Department of Thoracic Surgery, Tenri Hospital, Tenri, JPN
| | - Hirokazu Tanaka
- Department of Gastroenterological Surgery, Tenri Hospital, Tenri, JPN
| | | | | |
Collapse
|
6
|
Schulz SN, Miftaroski A, Rouiller B, Egger B, Lutz JA, Widmer L. Ultrasound-Guided Intranodal Lipiodol Lymphangiography for the Assessment and Treatment of Chylous Leaks: A Retrospective Case Series from a Single Center in Switzerland and a Systematic Review of the Literature. J Clin Med 2024; 13:6432. [PMID: 39518571 PMCID: PMC11547011 DOI: 10.3390/jcm13216432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 10/20/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
Background: Lymphatic leaks are well-known complications of major thoracic or abdominal surgeries, which significantly heighten morbidity and mortality rates. While the existing literature provides insights into managing these post-operative leaks, with a step-up approach from conservative measures (CMs) to surgical intervention, there are no standardized treatment guidelines. The purpose of this paper is to offer a management algorithm of post-operative lymphatic leaks based on a systematic literature review (SLR) of the therapeutic effect of Lipiodol lymphangiography (LL), completed by a case series of five patients who underwent LL in our department. Methods: In this IRB-approved study, we conducted an SLR following the PRISMA guidelines, using a PICOS. A quality assessment was performed for each study. The case series consisted of consecutive patients who underwent LL for diagnostic and therapeutic purposes at our institution between September 2018 and December 2020. Results: A total of 39 observational studies were included in the SLR comprising 11 retrospective case reviews (Group 1), and 3 case series as well as 25 case reports (Group 2). In total, these studies report cases of 557 patients (51.52% presenting oncological diagnoses; 43.98% having benefited from lymphadenectomy). Lymphatic or chylous fistulas were the most encountered complication, followed by chylothorax. The median volume of Lipiodol injected during lymphography was 11.7 mL (range: 9.8-75 mL). Overall, LL was technically successful in 77.7% (366/471) of patients. The clinical success of all technically successful LLs was 80.6% (295/366). Time-to-leak resolution after lymphography varied between 1 and 31 days. The factors associated with treatment failure were a high leak output (>500 mL/day) and Lipiodol extravasation on post-LL imaging. Our case series consisted of five patients (mean age: 62 ± 9.24 years; 20% female; 100% oncological diagnoses; 60% having beneficiated from lymphadenectomy). Technical and clinical successes were 80% (4/5) and 75% (3/4), respectively. Time-to-leak resolution varied between 1 and 4 days. The volume and technique of LL was not different from that identified in the SLR. Conclusions: LL is a safe procedure with high technical and clinical success rates that could be proposed as both a diagnostic and therapeutic solution for patients with post-operative central lymphatic lesions.
Collapse
Affiliation(s)
- Stephanie Nicole Schulz
- Department of Reconstructive, Esthetic, and Plastic Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - Almir Miftaroski
- Department of General Surgery, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland;
| | - Benoit Rouiller
- Department of Thoracic Surgery, Fribourg Cantonal Hospital, Chem. des Pensionnats 2/6, 1752 Villars-sur-Glâne, Switzerland; (B.R.); (J.A.L.)
| | - Bernard Egger
- Department of General Surgery, Fribourg Cantonal Hospital, Chem. des Pensionnats 2/6, 1752 Villars-sur-Glâne, Switzerland;
| | - Jon A. Lutz
- Department of Thoracic Surgery, Fribourg Cantonal Hospital, Chem. des Pensionnats 2/6, 1752 Villars-sur-Glâne, Switzerland; (B.R.); (J.A.L.)
| | - Lucien Widmer
- Department of Diagnostic and Interventional Radiology, Fribourg Cantonal Hospital, Chem. des Pensionnats 2/6, 1752 Villars-sur-Glâne, Switzerland
| |
Collapse
|
7
|
Metz AA, Steinbacher J, Roka-Palkovits J, Huettinger N, Tinhofer IE, Tzou CHJ, Rusli SM. Lymphatic Fistula Treatment: Indocyanine Green Lymphography-guided Microsurgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6168. [PMID: 39410971 PMCID: PMC11479424 DOI: 10.1097/gox.0000000000006168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 07/05/2024] [Indexed: 10/19/2024]
Abstract
Background Lymphatic fistulas are a common complication from surgery or interventional procedures resulting in persistent lymphatic leakage and delayed wound healing. The management of lymphatic fistula remains a subject of debate, ranging from conservative treatment to surgical lymphatic ligation. The implementation of a novel microsurgical approach involving lymphatic fistula ligation and/or lymphovenous anastomosis (LVA) using indocyanine green (ICG) lymphography is expected to decrease occurrence and complications. In this study, we share our experience in treating lymphatic fistula-guided microsurgical treatment. Methods A total of 13 patients from our hospital with persistent lymphatic fistula were enrolled in this retrospective study. Lymphatic fistulas and their leakages were identified and ligated by using ICG lymphography and a surgical microscope. In two cases, additional LVA surgery was performed. Results We were able to precisely identify lymphatic fistulas and treat them in all 13 patients. Lymph ligation was performed in all 13 cases, with additional distal LVA in two cases. In all patients, wound healing occurred following lymphatic ligation, except in one patient due to persistent infection. Patients with a lymphatic fistula were referred to our unit within 3 weeks to 1 year after onset, with an average consultation occurring after 5 months of persistent lymphatic fistula. Conclusions Targeted lymphatic vessel ligation with or without LVA with ICG-guided surgical microscope represents a promising highly efficacious therapy for persistent lymphatic fistula. This technique may accelerate wound healing and reduce hospitalization duration, thus advocating for its preferential use in managing lymphatic fistulas.
Collapse
Affiliation(s)
- Aaron Antaeus Metz
- From the Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria
| | - Johannes Steinbacher
- From the Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria
| | - Julia Roka-Palkovits
- From the Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria
| | - Nina Huettinger
- From the Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria
| | - Ines E Tinhofer
- From the Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria
| | - Chieh-Han John Tzou
- From the Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria
- Tzou Medical, Vienna, Austria
| | - Siti Muyassarah Rusli
- From the Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria
- Integrative Medicine Research Centre University, Universiti Islam Malaysia, Selangor, Malaysia
- Plastic, Reconstructive & Aesthetic Surgery Hospital, MSU Medical Centre, Selangor, Malaysia
| |
Collapse
|
8
|
Liu R, Cao L, Du J, Xie P. Intranodal lymphangiography combined with foam sclerotherapy embolization of thoracic duct in the treatment of postoperative chylous leakage for thyroid carcinoma: a case report and review. FRONTIERS IN RADIOLOGY 2024; 4:1476227. [PMID: 39399395 PMCID: PMC11470440 DOI: 10.3389/fradi.2024.1476227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 09/17/2024] [Indexed: 10/15/2024]
Abstract
Background Chylous leakage (CL) is a rare but significant complication following cervical lymph node dissection, particularly in patients with papillary thyroid carcinoma (PTC). This condition is characterized by the leakage of lymphatic fluid, which can result in severe consequences such as malnutrition, immunosuppression, and prolonged hospital stays. Conventional treatments for CL include conservative measures and surgical interventions, but these approaches often face limitations and challenges. This case report discusses a successful treatment of CL using thoracic duct lymphangiography combined with local injection of sclerotherapy, demonstrating a novel and effective approach for managing this complication. Case presentation A 72-year-old female patient with PTC underwent total thyroidectomy and bilateral Level VI and left Levels II, III, IV, and V cervical lymph node dissection. Postoperatively, the patient developed milky drainage indicative of CL. Despite initial conservative treatments including pressure bandaging, negative pressure drainage, and nutritional adjustments, the patient's condition did not improve. The patient declined surgical options, leading to the decision to perform thoracic duct lymphangiography combined with local injection of sclerotherapy. Under real-time ultrasound guidance, the inguinal lymph nodes were accessed, and lipiodol was injected to visualize the thoracic duct. Subsequently, foam sclerosant was injected at the leakage site under fluoroscopic guidance. The procedure resulted in a significant reduction of chyle leakage, and the patient was discharged with no recurrence during a 1-year follow-up. Conclusions This case illustrates that thoracic duct angiography combined with local injection of sclerotherapy can be an effective treatment for high-output CL when conservative measures fail and surgical intervention is not preferred. The approach offers a minimally invasive alternative that can reduce complications and improve patient outcomes. The successful management of CL in this case underscores the potential of advanced interventional techniques in treating lymphatic system complications and highlights the need for further research to establish standardized treatment protocols.
Collapse
Affiliation(s)
- RuiJiang Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lei Cao
- Radiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chinese Academy of Sciences, Chengdu, Sichuan, China
| | - JingXin Du
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ping Xie
- Radiology Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chinese Academy of Sciences, Chengdu, Sichuan, China
| |
Collapse
|
9
|
Deng X, Xia J. Refractory massive chylothorax following robot-assisted laparoscopic splenectomy with pericardial devascularization treated with trans-jugular intrahepatic portosystemic shunt: a case report. Front Med (Lausanne) 2024; 11:1420157. [PMID: 39296890 PMCID: PMC11408172 DOI: 10.3389/fmed.2024.1420157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/12/2024] [Indexed: 09/21/2024] Open
Abstract
The development of a chylothorax after robot-assisted laparoscopic splenectomy combined with pericardial devascularization (LSPD) is rare. The robot-assisted procedure is similar to the standard LSPD, but surgeons must remain vigilant about potential chylothorax caused by recurrence of portal hypertension in patients with cirrhosis, an event that leads to variceal bleeding in the gastric fundus or a massive chylothorax caused by a thoracic duct fistula. We report a rare case of massive chylothorax after robot-assisted LSPD and review the literature to help elucidate the mechanisms of portal hypertension after LSPD, reduce surgical complications, and improve long-term patient outcomes. After LSPD, portal pressure monitoring, coagulation function testing, and portal vein CT imaging help in excluding portal vein thromboses and ensuring appropriate anticoagulation to reduce the development of thoracic duct fistulas. If portal hypertension recurs after surgery and a high-output chylothorax develops, conservative treatment becomes ineffective. Treatment with an active trans-jugular intrahepatic portosystemic shunt (TIPS) is recommended to lower the portal pressure.
Collapse
Affiliation(s)
- Xiang Deng
- Department of Abdominal Surgery, Guiqian International Hospital, Guiyang, China
| | - Jun Xia
- Department of Abdominal Surgery, Guiqian International Hospital, Guiyang, China
| |
Collapse
|
10
|
Nuri T, Asaka A, Ota M, Yae Y, Tanaka Y, Osuga K, Takashima S, Ohmichi M, Otsuki Y, Ueda K. Treatment of Refractory Ascites with Lymphaticovenous Anastomosis Considering Lymphatic Territories. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6134. [PMID: 39247579 PMCID: PMC11379478 DOI: 10.1097/gox.0000000000006134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/17/2024] [Indexed: 09/10/2024]
Abstract
Lymphatic ascites is an infrequent complication observed in patients who have undergone lymphadenectomy as part of their surgical treatment for gynecological cancer. Previous research has suggested that intranodal lymphangiography can effectively manage lymphatic leakage. However, its efficacy diminishes for ascites with substantial fluid accumulation. This case report presents a patient who underwent lymphaticovenous anastomosis (LVA) for ascites that was unresponsive to lymphangiography and sclerotherapy. A 70-year-old woman required weekly ascites punctures after surgical treatment of ovarian cancer. Lymphoscintigraphy revealed lymphatic leakage originating from the right pelvic lymphatic vessel. Intranodal lymphangiography was performed from the inferior lateral inguinal region, followed by embolization with 33% NBCA. Despite these measures, recurrence of ascites and lower limb lymphedema were observed. LVA was conducted at 149 days after the primary operation. Before the LVA, indocyanine green was injected into the lateral and medial ankles, first and fourth toe web spaces, and lower abdomen. The indocyanine green lymphography revealed several linear patterns extending from the dorsum of the foot and the lower abdomen to the inguinal lymph node. Among these, the lymphatic vessels leading to the inferior lateral inguinal lymph node were chosen for the LVA. Eight anastomoses were executed at the right thigh, right lower leg, and right lower abdomen. The patient was discharged at 1 day postoperatively. A computed tomography examination conducted at 20 days post-LVA revealed no accumulation of ascites. To improve the success rate of LVA for ascites, a treatment strategy based on lymphatic territories is required.
Collapse
Affiliation(s)
- Takashi Nuri
- From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Akinori Asaka
- From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Mariko Ota
- From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuri Yae
- From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoshimichi Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Keigo Osuga
- Department of Radiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shogo Takashima
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yuki Otsuki
- From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Koichi Ueda
- From the Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| |
Collapse
|
11
|
Lee S, Luhar A, Miller J. Lymphatic Malformations: Review of Diagnosis and Management for the Interventional Radiologist. Semin Intervent Radiol 2024; 41:389-403. [PMID: 39524235 PMCID: PMC11543113 DOI: 10.1055/s-0044-1791281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Lymphatic malformations (LMs) arise from errors in lymphatic vascular development during embryogenesis and encompass an array of conditions that span from common cystic LMs to complex lymphatic anomalies (CLAs). Manifestations of LMs are wide-ranging, from clinically inconsequential to life-threatening. Proper diagnosis and management can be challenging and often benefit from an experienced multidisciplinary team. Cystic LMs are localized entities for which percutaneous sclerotherapy is the mainstay treatment. CLAs, on the other hand, are more diffuse in involvement and typically require multimodal therapy. With advances in the genetic understanding of LMs, targeted systemic therapies have been increasingly utilized with promising results. Thoracic duct interventions, both surgical and percutaneous, have a limited role in CLAs and should be approached cautiously to avoid significant complications. In this review, we discuss the genetic basis, imaging findings, and management options for LMs, with a particular focus on relevant interventional radiology techniques.
Collapse
Affiliation(s)
- Shimwoo Lee
- Department of Interventional Radiology, Children's Hospital Los Angeles, Los Angeles, California
| | - Aarti Luhar
- Department of Interventional Radiology, UCLA Ronald Reagan Medical Center, Los Angeles, California
| | - Joseph Miller
- Department of Interventional Radiology, Children's Hospital Los Angeles, Los Angeles, California
| |
Collapse
|
12
|
Treffy RW, Bakhaidar M, Shabani S. Delayed chylous fluid leakage at the surgical site following thoracic corpectomy via a lateral extracavitary approach: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24280. [PMID: 39074388 DOI: 10.3171/case24280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/07/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Chylous fluid leakage following spinal surgery is a rare and potentially difficult-to-manage complication that can lead to wound complications, pain, or nutritional deficiencies. Although the thoracic duct is localized near the thoracic spine, reports of thoracic duct injuries secondary to posterior thoracic spine surgery are rare. OBSERVATIONS The authors present the case of a 57-year-old male with a known history of metastatic renal cell carcinoma to the thoracic spine who had undergone a thoracolumbar fusion with thoracic corpectomy and presented with concern for a chyle leak almost a year after his surgery. The patient had a complicated oncological history and underwent decompression and fusion to treat his significant thoracic metastatic disease. A year later, he presented with back pain and a significant fluid collection at the surgical site, which was drained and found to be consistent with chyle. The patient was treated conservatively, and imaging of the thoracic duct a few months later demonstrated no direct injury, likely indicating either transient injury or potential obstruction of the thoracic duct from metastatic disease. LESSONS This case demonstrates a rare, potential complication when treating extensive thoracic metastatic disease as well as the workup and potential treatments when facing thoracic duct injury. https://thejns.org/doi/10.3171/CASE24280.
Collapse
Affiliation(s)
- Randall W Treffy
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamad Bakhaidar
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
13
|
Tan X, Luo G, Liao G, Liao H. Postoperative Chylous Ascites in Gynecological Malignancies: Two Case Reports and a Literature Review. Obstet Gynecol Int 2024; 2024:1810634. [PMID: 38957414 PMCID: PMC11219204 DOI: 10.1155/2024/1810634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/04/2023] [Accepted: 06/14/2024] [Indexed: 07/04/2024] Open
Abstract
Aim To explore the potential factors that influence the presentation and recovery of postoperative chylous ascites (CA) in gynecological malignancies. Methods We reported two cases of postoperative CA following gynecological surgery and reviewed the clinical features of 140 patients from 16 relevant papers. Patients' clinicopathological characteristics, surgical approach, and management were summarized. The onset and resolution times of postoperative CA in different groups were analyzed separately. Results The two patients in our report had recovery after conservative treatments. According to the literature review, the median time of onset of postoperative CA was 5 days (range, 0-75 days) after surgery. The median resolution time was 9 days (range, 2-90 days). Among patients, 87.14% of them had lymphadenectomy during gynecological surgeries, while 92.86% of the patients had resolution after conservative treatments. Conclusions Lymphadenectomy during surgery may be relevant to the postoperative CA. Conservative management could be the initial choice for postoperative CA treatment.
Collapse
Affiliation(s)
- Xin Tan
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - GuoLin Luo
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - Guangdong Liao
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - Hong Liao
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| |
Collapse
|
14
|
Kitashima F, Shimada N, Machii Y, Tanaka M. Successful Percutaneous Thoracic Duct Embolization for Chylothorax After Total Arch Replacement. Tex Heart Inst J 2024; 51:e228077. [PMID: 38623730 DOI: 10.14503/thij-22-8077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Chylothorax after cardiac surgery is a rare complication associated with severe morbidity and mortality. This report documents successful treatment with percutaneous thoracic duct embolization for chylothorax after total arch replacement. A 69-year-old man underwent replacement of the aortic arch to treat a ruptured aortic aneurysm. After surgery, the left thoracic drain discharged 2,000 to 3,000 mL serosanguineous fluid per day, even though the patient took nothing orally and was administered subcutaneous octreotide therapy. On postoperative day 9, percutaneous thoracic duct embolization was performed, and the drain could be removed. The chylothorax did not recur, and the patient was discharged on postoperative day 17.
Collapse
Affiliation(s)
- Fumihiro Kitashima
- Department of Cardiovascular Surgery, Tokyo West Tokusyukai Hospital, Tokyo, Japan
| | - Naohiro Shimada
- Department of Cardiovascular Surgery, Tokyo West Tokusyukai Hospital, Tokyo, Japan
| | - Yojiro Machii
- Department of Cardiovascular Surgery, Tokyo West Tokusyukai Hospital, Tokyo, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
15
|
Higami S, Tanaka Y, Maeda D, Yukimoto H, Ishii T, Shiki Y. Intranodal lymphangiography under microsurgery for refractory lymphatic ascites after pelvic lymphadenectomy. Gynecol Oncol Rep 2024; 52:101346. [PMID: 38404911 PMCID: PMC10885726 DOI: 10.1016/j.gore.2024.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024] Open
Abstract
Lymphatic ascites is a postoperative complication of lymph node dissection. Most symptomatic cases improve with conservative treatments. However, optimal management strategies for intractable lymphatic ascites remain controversial, and clinicians sometimes encounter intractable lymphatic ascites that does not respond to conservative management. We herein report a case of postoperative intractable lymphatic ascites that was successfully treated with intranodal lymphangiography (LG) from inguinal lymph nodes under microsurgery. A 56-year-old woman was diagnosed with stage II endometrial cancer and underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomies. On postoperative day (POD) 13, the patient presented with abdominal distention, and lymphatic ascites was diagnosed. Although the patient was treated with conservative management and lymphaticovenular anastomosis, her lymphatic ascites did not resolve. Finally, intranodal LG from the inguinal region was performed under microsurgery. A 2-cm incision was made on each side of the inguinal region. Once the lymph nodes were identified, a 23-gauge needle was inserted into the lymph node and lipiodol was injected. Extravasation of lipiodol into the abdomen from the left side of the lower pelvic region was confirmed. The postoperative course was uneventful. The ascites gradually decreased and disappeared within two weeks after LG.
Collapse
Affiliation(s)
- Shota Higami
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka, Japan
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yusuke Tanaka
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Daisuke Maeda
- Department of Plastic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hiroshi Yukimoto
- Department of Diagnostic Radiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Tomomi Ishii
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasuhiko Shiki
- Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| |
Collapse
|
16
|
Verhaeghe L, Holsbeeck AV, Bonne L, Claus E, Marrannes J, Vandenbulcke R, Jochmans I, Pirenne J, Maleux G. Therapeutic lymphangiography with ethiodized oil for the management of lymphoceles and chylous ascites. Diagn Interv Imaging 2023; 104:500-505. [PMID: 37210283 DOI: 10.1016/j.diii.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/28/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE The purpose of this study was to analyze the safety, technical success and clinical outcome of percutaneous intranodal ethiodized oil (Lipiodol®) based lymphangiography (L-LAG) for the management of refractory pelvic lymphoceles or chylous ascites using high doses of ethiodized oil. MATERIALS AND METHODS Thirty-four patients presenting with symptomatic, refractory postoperative pelvic lymphocele or chylous ascites referred for theranostic, inguinal, intranodal L-LAG treatment between May 2018 and November 2021 were retrospectively included. There were 21 men and 13 women, with a mean age of 62.7 ± 16.2 (standard deviation) years (age range: 9-86 years), who underwent a total of 49 L-LAG for the management of lymphoceles (n = 14), chylous ascites (n = 18) or a combination of lymphocele and chylous ascites (n = 2). Clinical and radiological pre-interventional, procedural and follow-up data up to January 2022 were collected from patients' electronic medical records and imaging files. RESULTS Technical success was obtained in 48 out of 49 L-LAG (98%). No complications related to L-LAG were noted. After one or more L-LAG, clinical success was obtained in 30 patients (88%) with a mean of 1.4 interventions per patient and mean intranodal injected volume of 29 mL of ethiodized oil per session. The remaining four patients (12%), with one or more failed L-LAG, underwent additional surgical intervention to definitively treat the postoperative lymphatic leakage. CONCLUSION L-LAG using high doses of ethiodized oil is a minimally invasive, safe and effective treatment of postoperative pelvic lymphocele or chylous ascites. Multiple sessions may be needed to obtain a meaningful clinical result.
Collapse
Affiliation(s)
- Laurence Verhaeghe
- Department of Radiology, General Hospital AZ Sint-Lucas/Sint-Jan, 8310 Bruges, Belgium; Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Andries Van Holsbeeck
- Department of Radiology, General Hospital AZ Sint-Lucas/Sint-Jan, 8310 Bruges, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Eveline Claus
- Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Jesse Marrannes
- Department of Radiology, General Hospital AZ Sint-Lucas/Sint-Jan, 8310 Bruges, Belgium
| | - Ruben Vandenbulcke
- Department of Radiology, General Hospital AZ Delta, 8800 Roeselare, Belgium
| | - Ina Jochmans
- Department of Abdominal Transplantation Surgery, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplantation Surgery, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium.
| |
Collapse
|
17
|
Kaminski LC, Wagenpfeil J, Buermann J, Lutz PL, Luetkens JA, Attenberger UI, Strassburg CP, Kalff JC, Schild HH, Pieper CC. Long-Term Clinical Outcome of Abdomino-Thoracic Lymphatic Interventions of Traumatic and Non-Traumatic Lymphatic Leakage in Adults. Biomedicines 2023; 11:2556. [PMID: 37760997 PMCID: PMC10526188 DOI: 10.3390/biomedicines11092556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/02/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this study was to retrospectively evaluate the long-term results of lymphatic interventions in adults with abdomino-thoracic lymphatic pathologies. Management of abdomino-thoracic chylous effusions in adults undergoing X-ray-lymphangiography with or without lymph-vessel embolization (LVE) from 2010-2018 was reviewed. Patients underwent lymphangiography alone when imaging showed normal findings or lymphatic obstruction without leakage or reflux; otherwise, LVE was performed (leakage, reflux, obstruction with leakage or reflux, lymphatic masses). Technical and clinical success, complications, and long-term outcomes were assessed. 78 patients (47 male, median age 56.3 years) were treated for chylous effusions (60.3% traumatic, 39.7% non-traumatic). Lymphangiography showed leakage (48.7%), reflux (14.1%), obstruction (28.2%), lymphatic masses (5.1%), and normal findings (3.8%). Embolization was performed in 49/78 (62.8%) cases. Overall, treatment was clinically successful in 74.4% (mean follow-up of 28 months), with significant differences between LVE and lymphangiography (91.8% vs. 44.8%; p < 0.001), traumatic and non-traumatic etiologies (89.4% vs. 51.6%; p < 0.001), and leakage locations (p = 0.003). The clinical success of LVE did not differ between leakage etiologies or locations. Complications occurred in 5 patients (2/5 needed treatment). Patients survived significantly longer after successful treatment (2679 vs. 927 days; p = 0.044) and without malignancy (3214 vs. 1550 days; p = 0.043). Lymphatic interventions are safe and effective. LVE should be attempted whenever feasible, as success is high (>90%). Successful intervention has a positive effect on patient survival.
Collapse
Affiliation(s)
- Lea C. Kaminski
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Julia Wagenpfeil
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Jens Buermann
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Philipp L. Lutz
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Ulrike I. Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | | | - Jörg C. Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Hans H. Schild
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Claus C. Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| |
Collapse
|
18
|
Nakamura Y, Doi K, Fujii R, Ogura H, Umeda E, Kato T, Sakai O, Shimabukuro K. Postoperative constrictive pericarditis caused rupture of lymphatic collaterals: a rare etiology of chylothorax. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2023; 2:81. [PMID: 39517060 PMCID: PMC11533690 DOI: 10.1186/s44215-023-00092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 07/18/2023] [Indexed: 11/16/2024]
Abstract
BACKGROUND Chylothorax after cardiovascular surgery is primarily caused by direct injury to the thoracic duct or its branches, and occurs in early postoperative period. In the present case, we describe a rare case of chylothorax manifesting three months after surgery secondary to constrictive pericarditis. CASE PRESENTATION A 71-year-old man underwent mitral valve replacement, tricuspid valve annuloplasty, and the maze procedure. He developed acute perioperative myocardial infarction on postoperative day one due to plaque rupture in the left anterior descending artery and underwent percutaneous coronary intervention. Although the patient was discharged on postoperative day 36, he required readmission on postoperative day 83 because of right side chylothorax associated with constrictive pericarditis. Lymphangiography revealed thoracic duct interruption and development of lymphatic collateral vessels via the right hilum. Single-photon emission computed tomography revealed abnormal tracer accumulation in the right hilum, suggesting a lymphatic leakage site. A catheter study indicated biventricular dip and plateau patterns with a reduced cardiac index (1.6 L/min/m2) and elevated central venous pressure (18 mmHg). Conservative treatment for chylothorax, including a low-fat diet and continuous drainage with chest tube, was unsuccessful. Drainage of chyle at approximately 500 mL/day continued. On hospitalization day 50, complete pericardiectomy via median sternotomy was performed because the patient's cardiac function deteriorated. The central venous pressure dramatically decreased, and the chylothorax gradually subsided. There was no recurrence of symptoms 1 year postoperatively. CONCLUSIONS Chylothorax associated with constrictive pericarditis subsequent to cardiac surgery is extremely rare. Although conservative management failed, the present case was successfully treated via pericardiectomy alone and did not require any additional precedures, such as thoracic duct ligation via a right thoracotomy.
Collapse
Affiliation(s)
- Yasuhito Nakamura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
| | - Ryo Fujii
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hiroki Ogura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Etsuji Umeda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takayoshi Kato
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Osamu Sakai
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Katsuya Shimabukuro
- Department of Cardiovascular Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| |
Collapse
|
19
|
Pieper CC. Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions. Invest Radiol 2023; 58:610-640. [PMID: 37058335 DOI: 10.1097/rli.0000000000000966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.
Collapse
Affiliation(s)
- Claus C Pieper
- From the Division for Minimally Invasive Lymphatic Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn; and Center for Rare Congenital Lymphatic Diseases, Center of Rare Diseases Bonn, Bonn, Germany
| |
Collapse
|
20
|
Zhao Q, Sun X, Liu K, Peng Y, Jin D, Shen W, Wang R. Correlation between capsule endoscopy classification and CT lymphangiography of primary intestinal lymphangiectasia. Clin Radiol 2023; 78:219-226. [PMID: 36509551 DOI: 10.1016/j.crad.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022]
Abstract
AIM To investigate the correlation between capsule endoscopy (CE) classification of primary intestinal lymphangiectasia (PIL) and computed tomography (CT) lymphangiography (CTL). MATERIALS AND METHODS A total of 52 patients with diagnosed PIL were enrolled. All patients were examined using CTL and small intestinal CE before surgery. CE assessments included the morphology, scope, colour, and size of lesions. CTL assessments included intestinal wall, lymphatic vessel dilatation, lymph fluid reflux, and lymphatic fistula. Patients were divided into three groups according to type diagnosed by CE, and the CTL characteristics were analysed among the groups. RESULTS CE showed 15 patients with type I, 27 with II, and 10 with type III. Intestinal wall thickening was observed in 15 type I, 21 type II, and seven type III. Pericardial effusion was observed in only three type I patients; the difference among types was statistically significant (p=0.02). Abnormal contrast agent distribution in the intestinal wall and mesentery was observed in 15 type II patients, and the difference was significantly greater than that of types I and III (p=0.02). Abnormal contrast agent distribution in the abdominal cavity was observed in 12 type II, and the difference was statistically significant (p=0.03). CONCLUSION The CE PIL classification reflects the extent and scope of intestinal mucosa lesions; CTL more systematically demonstrates abnormal lymphatic vessels or reflux, and its manifestations of PIL are related to the CE classification. The combination of CTL with CE is useful for accurately evaluating PIL, and provides guidance for preoperative assessment and treatment management of PIL patients.
Collapse
Affiliation(s)
- Q Zhao
- Department of Radiology, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - X Sun
- Department of Radiology, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - K Liu
- Department of Gastroenterology, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Y Peng
- Beijing Jiaotong University, China
| | - D Jin
- Peking University Third Hospital, China
| | - W Shen
- Department of Lymph Surgery, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - R Wang
- Department of Radiology, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
21
|
Hur S, Kim J, Ratnam L, Itkin M. Lymphatic Intervention, the Frontline of Modern Lymphatic Medicine: Part II. Classification and Treatment of the Lymphatic Disorders. Korean J Radiol 2023; 24:109-132. [PMID: 36725353 PMCID: PMC9892215 DOI: 10.3348/kjr.2022.0689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 01/28/2023] Open
Abstract
Lymphatic disorders encompass a broad spectrum of diseases involving the lymphatic system, ranging from traumatic lymphatic leaks to lymphatic malformations. Lymphatic disorders can be categorized into traumatic and non-traumatic disorders according to their etiology. These two categories may be further divided into subgroups depending on the anatomical location of the lymphatic pathology and their association with clinical syndromes. Thoracic duct embolization was a milestone in the field of lymphatic intervention that encouraged the application of percutaneous embolization techniques to treat leaks and reflux disorders in the lymphatic system. Additional access routes for embolization, including retrograde thoracic duct and transhepatic lymphatic access, have also been developed. This article comprehensively reviews a variety of options for the treatment of lymphatic disorders, from conservative management to the most recent embolization techniques.
Collapse
Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Korea.
| | - Lakshmi Ratnam
- Department of Radiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Maxim Itkin
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
22
|
Hur S, Kim J, Ratnam L, Itkin M. Lymphatic Intervention, the Frontline of Modern Lymphatic Medicine: Part I. History, Anatomy, Physiology, and Diagnostic Imaging of the Lymphatic System. Korean J Radiol 2023; 24:95-108. [PMID: 36725352 PMCID: PMC9892216 DOI: 10.3348/kjr.2022.0688] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 01/28/2023] Open
Abstract
Recent advances in lymphatic imaging have provided novel insights into the lymphatic system. Interventional radiology has played a significant role in the development of lymphatic imaging techniques and modalities. Radiologists should be familiar with the basic physiology and anatomy of the lymphatic system to understand the imaging features of lymphatic disorders, which reflect their pathophysiology. This study comprehensively reviews the physiological and anatomical aspects of the human lymphatic system as well as the latest lymphatic imaging techniques.
Collapse
Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Suwon, Korea.
| | - Lakshmi Ratnam
- Department of Radiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Maxim Itkin
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
23
|
Lympho-SPECT/CT as a Key Tool in the Management of a Patient with Chylous Ascites. Biomedicines 2023; 11:biomedicines11020282. [PMID: 36830819 PMCID: PMC9953622 DOI: 10.3390/biomedicines11020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Chylous ascites is a rare form of ascites usually associated with cirrhosis, abdominal malignancies, surgeries or infections. We presented a case of chylous ascites after robotic laparoscopic prostatectomy (PLDN-RALP), in which the correct diagnosis was achieved by SPECT/CT lymphoscintigraphy. A 72-year-old male developed chylous ascites after surgery and underwent lymphoscintigraphy with radiolabeled albumin nanocolloids for the supplementary study of the lymph flow and to detect a possible site of leakage. The scintigraphic imaging demonstrated the abdominal effusion and lymph stasis in the left iliac region. The combination of planar imaging with SPECT/CT can resolve the assessment of chylous disorders.
Collapse
|
24
|
Sheela C, Thomas R, Yadav M, Sasidharan K. Chylous ascites following laparoscopic donor nephrectomy: Report of a case and a brief overview. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_67_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
25
|
Lee K, Chang SJ, Won JH, Kwon Y, Kim SH, Kim JE, Kim J. Intranodal Lymphangiography and Embolization for the Treatment of Early Postoperative Lymphatic Leaks after Pelvic Surgery. J Vasc Interv Radiol 2022; 34:591-599.e1. [PMID: 36526076 DOI: 10.1016/j.jvir.2022.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess outcome and predictors of outcome after lymphatic embolization (LE) for early postoperative lymphatic leak after pelvic surgery. MATERIAL AND METHODS Lymphangiography (LG) procedures performed between May 2015 and February 2020 for postoperative intraperitoneal lymphatic leaks after pelvic surgery were reviewed. Treatment indication was lymphatic drainage of >500 mL/d persisting for >1 week. LE was performed by injecting glue into the iliac lymph node. Fisher exact and Wilcoxon rank-sum tests were used for comparative analysis, and logistic regression was used to assess predictors of outcome. RESULTS LG was performed in 71 patients. A leak was demonstrated in 69 patients who underwent LE. The mean drainage was 1,329 mL/d ± 773. Catheters were removed in 49 (69.0%) patients after 1 procedure and in 69 (97.2%) patients after a mean of 1.3 procedures. The mean drainage at the time of catheter removal was 157 mL/d ± 100. Failure occurred in 12 (16.9%) cases, including 2 (2.8%) cases of unsuccessful catheter removal and 10 (14.1%) cases of catheter reinsertion owing to recurrent ascites (n = 3) and lymphoceles (n = 7). Older age and drainage of >1,500 mL/d were associated with failure (P = .004). Drainage of >1,500 mL/d was associated with a post-LE catheter dwell time of longer than 1 week (P = .024). Minor adverse events were noted in 4 (5.6%) patients who presented with transient leg swelling. CONCLUSIONS LE was effective for treating pelvic surgery-related lymphatic leaks. Reintervention may be required. Drainage of >1,500 mL/d was associated with clinical failure and a post-LE catheter dwell time of longer than 1 week.
Collapse
Affiliation(s)
- Kyungmin Lee
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Ho Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Eun Kim
- Department of Radiology, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
| |
Collapse
|
26
|
Yang Q, Bai X, Bao H, Li Y, Men W, Lv L, Liu Z, Han X, Li W. Invasive treatment of persistent postoperative chylothorax secondary to thoracic duct variation injury: Two case reports and literature review. Medicine (Baltimore) 2022; 101:e31383. [PMID: 36316910 PMCID: PMC9622594 DOI: 10.1097/md.0000000000031383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Postoperative chylothorax is a rare complication after pulmonary resection. Thoracic duct variations may play a key role in postoperative chylothorax occurrence and make treatment difficult. No studies in the literature have reported the successful treatment of chylothorax second to thoracic duct variation by lipiodol-based lymphangiography. PATIENT CONCERNS A 63-year-old male and a 28-year-old female with primary lung adenocarcinoma were treated by video-assisted thoracoscopic cancer resection, and suffered postoperative chylothorax. Conservative treatment was ineffective, including nil per os, persistent thoracic drainage, fatty food restriction, and somatostatin administration. DIAGNOSIS Postoperative chylothorax. INTERVENTIONS Patients received lipiodol-based lymphangiography under fluoroscopic guidance. Iatrogenic injuries were identified at thoracic duct variations, including an additional channel in case 1 and the lymphatic plexus instead of the thoracic duct in case 2. OUTCOMES Thoracic duct variations were identified by lipiodol-based lymphangiography, and postoperative chylothorax was successfully treated by lipiodol embolizing effect. LESSONS Thoracic duct variations should be considered after the failure of conservative treatment for postoperative chylothorax secondary to pulmonary resection. Lipiodol-based lymphangiography is valuable for identifying the thoracic duct variations and embolizing chylous leakage.
Collapse
Affiliation(s)
- Qiwei Yang
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xu Bai
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Han Bao
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yukang Li
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wanfu Men
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ling Lv
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhenghua Liu
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiangjun Han
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
- *Correspondence: Xiangjun Han, Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China (e-mail: )
| | - Wenya Li
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
27
|
Gupta A, Naranje P, Vora Z, Sharma R, Jana M, Bhalla AS, Sinha P, Malik R, Goel P, Dhua A, Kandasamy D. Intranodal lipiodol injection for the treatment of chyle leak in children - a preliminary experience. Br J Radiol 2022; 95:20211270. [PMID: 35856789 PMCID: PMC10996956 DOI: 10.1259/bjr.20211270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of intranodal lymphangiography using ethiodised oil (Lipiodol; Guerbet Japan, Tokyo, Japan) for the treatment of refractory cases of chylothorax and chylous ascites in the paediatric population. METHODS Between 2016 and 2020, eight children having chyle leak resistant to conservative management underwent intranodal lymphangiography using lipiodol injection. After ethical approval by the Institutional Review Board, these patients' data were retrospectively analysed. Technical success was defined by opacification of inguinal and retroperitoneal lymphatics while injection on fluoroscopy. Clinical success was defined as progressively decreasing drain output and eventual cessation of output within a week after the procedure. Long-term follow up was done as feasible. RESULTS Technical success was achieved in all the patients. Complete cessation of drain output was noted within 1 week of procedure in all patients indicating clinical success. One patient had recurrence of chylous leakage after an interval of 1 month and intranodal lymphangiography was repeated for that patient. The child had technical as well as clinical success after the repeat procedure. Hence a total of 9 procedures were performed in 8 patients. CONCLUSION Intranodal lymphangiography may prove to be a valuable minimally invasive therapeutic tool in cases of refractory chylous leakage in paediatric patients with minimal risk of complications. ADVANCES IN KNOWLEDGE Intranodal lymphangiography using lipiodol may prove to be a minimally invasive alternative in paediatric patients with refractory lymphatic leaks.
Collapse
Affiliation(s)
- Amit Gupta
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| | - Zainab Vora
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| | - Pallavi Sinha
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| | - Rohan Malik
- Department of Pediatrics, All India Institute of Medical
Sciences, New Delhi,
India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical
Sciences, New Delhi,
India
| | - Anjan Dhua
- Department of Pediatric Surgery, All India Institute of Medical
Sciences, New Delhi,
India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis and Interventional Radiology, All
India Institute of Medical Sciences, New
Delhi, India
| |
Collapse
|
28
|
Liu HT, Liu CA, Wang HK, Liu CS, Shen SH. Minimal invasive treatment for post-liver and renal transplant lymphatic leaks. Clin Transplant 2022; 36:e14691. [PMID: 35485283 DOI: 10.1111/ctr.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Persistent lymphatic leakage from the surgical drain is a troubling complication occasionally encountered postoperatively. This study investigated lymphatic leaks after renal or liver transplantation, comparing the treatment efficacy of traditional catheter drainage vs. minimally invasive lymphatic interventions. We also discuss access and treatment targets considering the physiology of lymphatic flow. METHODS Between September 2018 and September 2020, 13 patients with lymphatic leakage were treated with minimally invasive lymphatic interventions; 11 had received a renal transplant, and two received a liver transplant. The control group included 10 patients with post-renal transplant lymphatic leakage treated with catheter drainage. The treatment efficacy of catheter drainage, lymphatic interventions, and different targets of embolization were compared. RESULTS The technical success rate for lymphatic intervention was 100%, and the clinical success rate was 92%, with an 82.9% percent reduction in drain volume on the first day after treatment. The duration to reach clinical success was 5.9 days with lymphatic intervention, and 33.9 days with conservative catheter drainage. CONCLUSION Lymphangiography and embolization are minimally invasive and efficient procedures for treating persistent lymphatic leaks after renal or liver transplantation. We suggest prompt diagnosis and embolization at upstream lymphatics to reduce the duration of drain retention, days of hospitalization and associated comorbidities. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Hsien-Tzu Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Radiology, Shuang-Ho Hospital, Taiwan, New Taipei City, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Su Liu
- National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Transplantation Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
29
|
Imai H, Yoshida S, Mese T, Roh S, Koshima I. Supermicrosurgical lymphatic venous anastomosis for intractable lymphocele after great saphenous vein harvesting graft. J Vasc Surg Cases Innov Tech 2022; 8:45-47. [PMID: 35097247 PMCID: PMC8783068 DOI: 10.1016/j.jvscit.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022] Open
Abstract
Lymphoceles result from either trauma to the lymphatic vessels or after vein graft harvest, which occurs in 10% to 16% of patients. When a lymphocele persists despite conservative treatment, patients can experience undue distress. We have reported the case of successful treatment using lymphatic venous anastomosis (LVA) of an intractable lymphocele that had been refractory to conservative treatment, including stretch bandaging, drainage, and local injection for 2 years after great saphenous vein harvest. The lymphocele resolved shortly after the LVA without any adverse effects. LVA can be a useful and minimally invasive alternative treatment of lymphocele after harvesting the great saphenous vein.
Collapse
|
30
|
Kalia S, Narkhede A, Yadav AK, Bhalla AK, Gupta A. Retrograde transvenous selective lymphatic duct embolization in post donor nephrectomy chylous ascites. CEN Case Rep 2022; 11:1-5. [PMID: 34218419 PMCID: PMC8811106 DOI: 10.1007/s13730-021-00618-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Chylous ascites is a rare, potentially sinister complication in post donor nephrectomy patients which may cause significant morbidity in form of severe malnutrition and an immuno-compromised state. We present two patients with post donor nephrectomy-related chylous leaks who failed conservative treatment. In both cases, lymphangiography was done first to detect the chylous leak site in the left renal fossa, and thereafter transvenous retrograde approach via left subclavian vein with selective lymphatic duct embolization of chylous leak was done with coils and glue successfully. Chylous ascites resolved in both patients after the embolization. Hence retrograde transvenous embolization technique appears to be an effective management option for refractory chylous leaks.
Collapse
Affiliation(s)
- Shekhar Kalia
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Amey Narkhede
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajit Kumar Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.
| | | | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
31
|
Lympho-venous anastomosis for the treatment of congenital and acquired lesions of the central lymphatic system: a multidisciplinary treatment approach. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
32
|
Lee YJ, Lee IJ, Park S, Kim TS, Lim MC. Transvaginal lymphatic embolization of the fistula between a pelvic lymphocele and the vaginal stump following radical hysterectomy and sentinel pelvic lymph node biopsy in a patient with cervical cancer: A case report. Mol Clin Oncol 2022; 16:49. [PMID: 35003747 PMCID: PMC8739719 DOI: 10.3892/mco.2021.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
A lymphocele is a common complication that occurs following pelvic lymph node dissection. However, the complication of lymphoceles following sentinel pelvic lymph node biopsy has not been previously reported, to the best of our knowledge. A 49-year-old female patient had undergone radical hysterectomy and pelvic lymph node biopsy for stage IB1 cervical cancer 5 months previously and presented with a profuse watery vaginal discharge of ~2 liters per day. A fistula connecting the lymphocele and the vaginal stump was identified using lymphoscintigraphy and single photon emission CT/CT. Transvaginal lymphatic embolization was successfully performed through the vaginal fistulous tract, resulting in immediate reduction of the vaginal discharge. In conclusion, the case of fistula formation between pelvic lymphocele and vaginal stump was encountered at our department and was reported with a literature review. To the best of our knowledge, there are no previous reports on lymphoceles with direct communication to the vaginal mucosa, particularly following sentinel pelvic lymph node biopsy. The present study reported the case of a patient who was successfully treated for a pelvic lymphocele with direct communication to the vaginal mucosa.
Collapse
Affiliation(s)
- Yeon Jee Lee
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Republic of Korea
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Republic of Korea
| | - Sohyun Park
- Department of Nuclear Medicine, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Republic of Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Republic of Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Republic of Korea.,Division of Tumor Immunology, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Republic of Korea.,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Republic of Korea
| |
Collapse
|
33
|
Westerman ME, Yevich SM, Dori Y, Ward JF, Pisters LL, Karam JA, Wood CG, Avritscher R, Matin SF. Lymphangioembolization for iatrogenic chylous ascites after retroperitoneal urologic surgery. BJU Int 2021; 129:585-587. [PMID: 34962705 DOI: 10.1111/bju.15637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mary E Westerman
- The University of Texas, M.D. Anderson Cancer Center, Department of Urology
| | - Steven M Yevich
- The University of Texas, M.D. Anderson Cancer Center, Department of Interventional Radiology
| | - Yoav Dori
- Center for Lymphatic Imaging and Interventions and the Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John F Ward
- The University of Texas, M.D. Anderson Cancer Center, Department of Urology
| | - Louis L Pisters
- The University of Texas, M.D. Anderson Cancer Center, Department of Urology
| | - Jose A Karam
- The University of Texas, M.D. Anderson Cancer Center, Department of Urology
| | - Christopher G Wood
- The University of Texas, M.D. Anderson Cancer Center, Department of Urology
| | - Rony Avritscher
- The University of Texas, M.D. Anderson Cancer Center, Department of Interventional Radiology
| | - Surena F Matin
- The University of Texas, M.D. Anderson Cancer Center, Department of Urology
| |
Collapse
|
34
|
Li L, Wu X, Liu D, Zhang W, Yang L, Pan F. Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax. Front Med (Lausanne) 2021; 8:754781. [PMID: 34977063 PMCID: PMC8714876 DOI: 10.3389/fmed.2021.754781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To preliminarily explore the safety and effectiveness of transpedal lymphangiography (TL) with high-dose ethiodized oil application (>20 ml) in the treatment of high-output postoperative chylothorax.Methods: From 1 July 2020 to 1 July 2021, a total of 7 patients with high-flow postoperative chylothorax (> 1,000 ml/d) were retrospectively reviewed in a single center. Clinical data, including surgery types, technical and treatment success of TL, and adverse events of TL, were collected and analyzed.Results: Seven patients (5 cases of non-small cell lung cancer; 2 cases of esophageal carcinoma) with a median age of 62 years (range: 30–70 years) occurred postoperative chylothorax after tumor resection with mediastinal lymphadenectomy. All patients received conservative treatment including total parenteral nutrition and somatostatin administration for a median of 20 days (range: 15–31 days) that failed to cure the chylothorax, so TL was performed as a salvage. Before TL, the median daily chyle output was 1,500 ml/day (range: 1,100–2,000 ml/day). The technical success rate of TL was 100% (7/7), with the median volume of ethiodized oil of 27.6 ml (range: 21.2–30.0 ml) injected in TL. Ruptured thoracic duct was identified in 5 patients (5/7, 71%) in fluoroscopy and chest CT after TL. The treatment success rate of TL was 86% (6/7). In 6 patients, the thoracic drainage was removed after a median of 7 days (range: 4–13 days) from TL performance. No adverse event of TL was reported.Conclusion: Transpedal lymphangiography with high-dose ethiodized oil application (>20 ml) is a feasible, safe, and effective modality for the treatment of high-flow (> 1,000 ml/day) postoperative chylothorax.
Collapse
Affiliation(s)
- Lin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xin Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Dehan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wei Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Feng Pan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- *Correspondence: Feng Pan
| |
Collapse
|
35
|
Bent C. Percutaneous Translymphocele Embolization of Retroperitoneal Lymphatic Leak. Vasc Endovascular Surg 2021; 56:225-228. [PMID: 34879751 DOI: 10.1177/15385744211062317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Iodized oil-based lymphangiography (LAG) is a well-established diagnostic exam during the workup of postoperative lymphatic leaks. Computed tomography (CT) has been shown to be a useful complement to optimize treatment planning and can easily be performed after conventional LAG. The treatment options for lymphatic leaks include conservative dietary modification, sclerotherapy, embolization, and surgery. We present a case of a 48-year-old man who developed a symptomatic left retroperitoneal lymphatic fluid collection after left nephrectomy, complicated by postoperative retroperitoneal abscess. Retroperitoneal duct leak was confirmed via ultrasound-guided intranodal LAG and post-LAG CT. This leak was successfully managed with N-butyl cyanoacrylate glue embolization of the leaking lymphatics via fluoroscopic-guided catheterization of the leak via percutaneous access through the lymphatic fluid collection.
Collapse
Affiliation(s)
- Chris Bent
- Department of Radiology, 472028Riverside University Health System, Moreno Valley, CA, USA
| |
Collapse
|
36
|
Chen L, Lin L, Li L, Xie Z, He H, Lin C, Chen J, Lin A. Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case-control study. BMC Cancer 2021; 21:1242. [PMID: 34794409 PMCID: PMC8603468 DOI: 10.1186/s12885-021-08984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy. METHODS This retrospective study screened consecutive patients with cervical cancer (stage Ia2-IIb). RESULTS Among 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%). Median time from surgery to onset of PLL was 6 days (range, 4-21 days). All cases resolved in a median 10 days (range, 3-56 days) after conservative treatment; although one case experienced recurrence of vaginal drainage after 26 days, this also resolved after conservative therapy. Multivariate analysis showed that two cycles of neoadjuvant chemotherapy (odds ratio [OR], 3.283; 95% confidence interval [95%CI], 1.289-8.360; P = 0.013), a decrease in hemoglobin level of ≥20 and < 30 g/L (OR, 6.175; 95%CI, 1.033-10.919; P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248-17.426; P = 0.029), and postoperative albumin level ≥ 30 and < 35 g/L (OR, 2.552; 95%CI, 1.112-5.857; P = 0.027) or < 30 g/L (OR, 5.517; 95%CI, 2.047-18.148; P = 0.012) were associated with PLL. CONCLUSION Neoadjuvant chemotherapy, postoperative anemia and postoperative hypoproteinemia are risk factors for PLL.
Collapse
Affiliation(s)
- Li Chen
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Liang Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Ling Li
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Zuolian Xie
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Haixin He
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Cuibo Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Jian Chen
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - An Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China.
| |
Collapse
|
37
|
Verhaeghe L, Van Holsbeeck A, Kager J, Ampe J, Mermuys K, Maleux G. Postoperative lymphocele causing obturator nerve entrapment, treated with percutaneous drainage and intranodal poppyseed oil (Lipiodol)-based lymphangiography. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:698-700. [PMID: 34746534 PMCID: PMC8556490 DOI: 10.1016/j.jvscit.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/12/2021] [Indexed: 11/17/2022]
Abstract
Obturator nerve entrapment is a rare complication after pelvic surgery and is caused by a direct intraoperative injury or secondary to compression by a postoperative collection. We have presented the case of a 65-year-old man who had complained of right-sided medial groin pain 4 weeks after robot-assisted laparoscopic prostatectomy with bilateral pelvic lymphadenectomy. Pelvic magnetic resonance imaging showed bilateral lymphoceles with right-sided compression of the obturator nerve causing diffuse muscle edema in its innervation region. Percutaneous drainage and intranodal poppyseed oil (Lipiodol)-based lymphangiography led to a complete resolution of his symptoms.
Collapse
Affiliation(s)
| | - Andries Van Holsbeeck
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Radiology, AZ Sint-Jan Bruges Hospitals, Bruges, Belgium
| | - Joost Kager
- Department of Radiology, AZ Sint-Jan Bruges Hospitals, Bruges, Belgium
| | - Jozef Ampe
- Department of Urology, AZ Sint-Jan Bruges Hospitals, Bruges, Belgium
| | - Koen Mermuys
- Department of Radiology, AZ Sint-Jan Bruges Hospitals, Bruges, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Correspondence: Geert Maleux, MD, PhD, Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| |
Collapse
|
38
|
Kwon Y, Kim MJ. The Update of Treatment for Primary Intestinal Lymphangiectasia. Pediatr Gastroenterol Hepatol Nutr 2021; 24:413-422. [PMID: 34557394 PMCID: PMC8443852 DOI: 10.5223/pghn.2021.24.5.413] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022] Open
Abstract
Intestinal lymphangiectasia is a rare disease which is causing protein-losing enteropathy. Treatment of intestinal lymphangiectasia can be a challenge for clinicians because of the lack of specific guidelines regarding pharmacological indications. We sought to introduce a diagnostic approach and suggest guidelines for treatment. After exclusion of secondary intestinal lymphangiectasia, magnetic resonance lymphangiography is a promising tool for the assessment of abnormal lymphatic lesions in primary intestinal lymphangiectasia. Determining the extent of the lesion provides direction for treatment options. Focal short-segment intestinal lymphangiectasia can be treated via intestinal resection or radiologic embolization after dietary therapy failure. Diffuse intestinal lymphangiectasia and extensive lymphangiectasia should be treated with several drugs with a full understanding of their mechanisms.
Collapse
Affiliation(s)
- Yiyoung Kwon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Intranodal Lymphangiography during Surgical Repair of Pelvic Lymphorrhea after Radical Cystectomy. Case Rep Urol 2021; 2021:7822422. [PMID: 34327035 PMCID: PMC8277509 DOI: 10.1155/2021/7822422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022] Open
Abstract
Lymphorrhea can develop after various types of surgeries. Surgical closure of the lymphatic leakage point is an effective treatment option. However, it is difficult to identify the leakage point sometimes. Here, we report a case of pelvic lymphorrhea after radical cystectomy for bladder cancer. Identification of the leakage point was difficult during laparoscopic surgical repair of lymphorrhea. Intranodal lymphangiography was performed via the inguinal lymph node by injection of lipiodol, followed by injection of indigo carmine. Laparoscopy revealed extravasation of lipiodol and indigo carmine from the pelvic wall. The leakage point was successfully cauterized using an electric scalpel. Lymphorrhea improved after the surgical repair. This case suggests that intranodal lymphangiography may be useful for detecting the site of lymphatic leakage during the surgical repair of lymphorrhea.
Collapse
|
40
|
Vora ZA, Kandasamy D, Naranje P, Malik R. Pediatric chylous ascites treatment with combined ultrasound and fluoroscopy-guided intranodal lymphangiography. Indian J Radiol Imaging 2021; 29:226-228. [PMID: 31367098 PMCID: PMC6639871 DOI: 10.4103/ijri.ijri_424_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Chylous ascites is a form of ascites resulting from the leakage of lymph into the peritoneal cavity, which is particularly rare in children, most common etiology being an iatrogenic injury to lymphatics during surgery. Initial conservative management options include medium-chain triglycerides-based diet, somatostatin analogs, and total parenteral nutrition. If these fail, then interventions such as paracentesis with sclerotherapy, surgical ligation, or peritoneal shunts have been described. This study reports a case of a 7-year-old child with refractory chylous ascites to demonstrate a minimally invasive technique of intranodal lymphangiography with lipiodol as a viable treatment option for chylous ascites in children, particularly in cases of minor and undetectable leaks.
Collapse
Affiliation(s)
- Zainab A Vora
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Priyanka Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Malik
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
41
|
Flores-Funes D, Miguel Perelló JA, Capel-Alemán A, Flores-Pastor BM. Percutaneous embolization of the thoracic duct as a therapeutic alternative to chylous fistula after thyroid surgery. ENDOCRINOL DIAB NUTR 2021; 68:211-213. [PMID: 34167701 DOI: 10.1016/j.endien.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Diego Flores-Funes
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, Spain; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain.
| | - Joana Aina Miguel Perelló
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, Spain; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain
| | - Antonio Capel-Alemán
- Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain; Servicio de Radiología, Unidad de Radiología Vascular Intervencionista, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Benito Manuel Flores-Pastor
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, Spain; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain
| |
Collapse
|
42
|
Stange S, Sziklavari Z. [Modern Treatment Options for Postoperative Chylothorax: a Systematic Review]. Pneumologie 2021; 75:439-446. [PMID: 34116575 DOI: 10.1055/a-1172-7288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chylothorax is a multifactorial complication, usually caused by surgery or traumatic injury, and more rarely by malignant disease. Because of the lack of prospective, randomised trials, the evidence-based treatment rests upon personal experience, but ideally taking into account retrospective analysis. MATERIAL AND METHODS The aim of this review is to provide a comprehensive overview of the currently available modern treatment options. Another aspect is to show their advantages and disadvantages. For this purpose, a literature search was performed using the "PubMed" database. Publications older than ten years were excluded from this review. The literature search employed the keyword "chylothorax". The priority was set on publications including a comparative assessment of treatment approaches. The authors relied on many years of clinical experience to critically analyse and evaluate the treatment options and the given recommendations. RESULTS The success rate of the conservative treatment methods ranges widely, depending on the underlying cause of the disease (3-90 %). Non-invasive or semi-invasive procedures are successful in 50 to 100 % of the cases, also depending on the aetiology. After unsuccessful conservative treatment of operable patients, the standard surgical therapy consists of thoracic duct ligature, which is usually performed thoracoscopically. Alternatively, pleurodesis or the placement of a permanent chest drain (PleurX) or a pleuroperitoneal shunt may be performed. The success rate of these procedures is between 64 and 100 %. The morbidity and mortality rate can reach values up to 25 %. CONCLUSION Treatment of a chylothorax should be started conservatively. Subsequently, a more aggressive therapy may be gradually considered, based on the patient's health and the amount of the secretion. Interventional radiological procedures are safe, successful, and have a legitimate place alongside conservative or surgical treatment. However, they are currently only available in some larger centres.
Collapse
Affiliation(s)
- S Stange
- Klinik für Thoraxchirurgie, Regiomed Kliniken GmbH, Sonneberg/Coburg
| | - Z Sziklavari
- Klinik für Thoraxchirurgie, Regiomed Kliniken GmbH, Sonneberg/Coburg
| |
Collapse
|
43
|
Intranodal Lymphangiography With High-Dose Ethiodized Oil Shows Efficient Results in Patients With Refractory, High-Output Postsurgical Chylothorax: A Retrospective Study. AJR Am J Roentgenol 2021; 217:433-438. [PMID: 34106766 DOI: 10.2214/ajr.20.23465] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study is to evaluate the safety and efficacy of intranodal lymphangiography (INL) with high-dose ethiodized oil in patients with postoperative refractory chylothorax. MATERIALS AND METHODS. A retrospective review of a cohort of 18 patients with refractory postoperative chylothorax seen between May 2015 and March 2019 was conducted. All patients underwent intranodal lymphangiography with high doses of ethiodized oil (mean, 75 mL; range, 40-140 mL). The following information was gathered from the institutional database: patient demographics, type of surgery, output volumes, interval between surgery and lymphangiography, imaging results, amount of ethiodized oil injected, clinical success, and time to resolution. RESULTS. Of the 18 patients, 11 (61%) had previously undergone thoracic duct ligation, and seven (39%) had not. A lymphatic leak was confirmed by lymphangiography in 12 of 18 patients (67%). A total of five patients underwent a second session of INL, which was successful in three of the patients (60%). Removal of all chest tubes was possible in 15 of 18 patients (83%) after a mean of 12 days (range, 1-25 days). Two patients had an anastomotic leak develop after esophagectomy and died with their chest tubes in situ. One patient underwent thoracic duct ligation after two failed INL procedures. No complications were recorded. CONCLUSION. INL with a high dose of injected ethiodized oil is a safe and effective procedure for the management of postsurgical refractory chylothorax, with chest tube removal in 83% of patients.
Collapse
|
44
|
Kwon Y, Kim ES, Choe YH, Hyun D, Kim MJ. Therapeutic Lymphatic Embolization in Pediatric Primary Intestinal Lymphangiectasia. Yonsei Med J 2021; 62:470-473. [PMID: 33908219 PMCID: PMC8084696 DOI: 10.3349/ymj.2021.62.5.470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/27/2022] Open
Abstract
Primary intestinal lymphangiectasia (IL) can cause leakage of lymphatic fluids into the gastrointestinal tract, eventually leading to protein-losing enteropathy. A 15-year-old male patient, whose disease began at the age of 8 years, recently felt worsening general weakness. After diagnosing abnormal lymphatic lesions in the duodenum through endoscopy with biopsy and contrast-enhanced magnetic resonance lymphangiography, glue embolization of the leaking duodenal lymphatic channel was successfully performed. This procedure is typically reserved for adult patients, although as shown in this case, it can be properly performed in children. His serum albumin level was initially 1.5 g/dL, but elevated to 5.0 g/dL after two sessions of lymphatic embolization. Accordingly, we suggest that embolization could potentially be considered a first-line treatment for focal lesions of primary intestinal IL.
Collapse
Affiliation(s)
- Yiyoung Kwon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sil Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yon Ho Choe
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
45
|
CAMPISI C, WITTE M, CAMPISI CS, MOLINARI L, FULCHERI E, VILLA G, SUKKAR SG, DE CARO G, ROSSI U, PETROCELLI F, TACCHELLA M, MARENCO R, RISSO R, DEMORO A, CAMPISI CC. Matching primary with secondary lymphedemas across lymphatic surgery in Genoa (Italy) from 1973 until time of COVID-19. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021; 28. [DOI: 10.23736/s1824-4777.21.01495-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
46
|
Ding PX, Liu C, Lu HB, Wang L, Li ZM, Lee EW. Giant mediastinal lymphocele after esophagectomy successfully treated with thoracic duct embolization. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:215-218. [PMID: 33997556 PMCID: PMC8093313 DOI: 10.1016/j.jvscit.2020.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
A 64-year old man had developed a giant mediastinal lymphocele after undergoing esophagectomy for the treatment of esophageal squamous cell carcinoma. The thoracic duct was embolized with six micro-coils, followed by embolization using a 1:3 mixture of N-butyl-2-cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany) and ethiodized oil. Resolution of the lymphocele was achieved within 5 days after embolization. To the best of our knowledge, ours is the first reported case of thoracic duct embolization for the treatment of mediastinal lymphocele.
Collapse
Affiliation(s)
- Peng-Xu Ding
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Liu
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui-Bin Lu
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Wang
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zong-Ming Li
- Department of Intervention, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif
| |
Collapse
|
47
|
Kwon Y, Kim ES, Choe YH, Kim MJ. Individual approach for treatment of primary intestinal lymphangiectasia in children: single-center experience and review of the literature. BMC Pediatr 2021; 21:21. [PMID: 33407260 PMCID: PMC7789338 DOI: 10.1186/s12887-020-02447-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background Intestinal lymphangiectasia is a rare disease. Thus, prospective studies are impossible, and therapy is still controversial. Several medicines are suggested for treatment but there are no existing indications for drug choice and treatment guidelines. We aimed to introduce the action mechanism of each drug and treatment overview in a single-center experience and a review of the literature on second-line therapy for primary intestinal lymphangiectasia. Method Children under 18 years old diagnosed with intestinal lymphangiectasia from June 2000 to June 2020 were included and retrospectively reviewed in the study. Capsule endoscopy, MR lymphangiography, or whole-body MRI for investigating the extent of abnormal lymphatic vessels in addition to endoscopy and biopsy were conducted. The individual treatment approaches depended upon the lymphangiectasis locations involved. Results Only one patient showed a response to dietary therapy. One patient was successfully cured after two therapeutic lymphatic embolization. Octreotide was tried for two patients who had extensive lymphangiectasis. Lymphangiectasis recurred when octreotide was used for 3 months in one patient, and there was no effect in the other patient. Sirolimus was tried for four patients. Two of them had abnormal lymphatic lesions only in the intestine, and the others had extensive lymphangiectasis. The former group showed clinical improvement after 3–4 months of sirolimus treatment, whereas the latter group showed clinical improvement only after 1 month of sirolimus treatment. Conclusion Surgery or embolization is a potential therapeutic option for patients with focal abnormal lymphatic lesions. Octreotide is not an optimal choice for patients with extensive lymphangiectasis. Sirolimus is an effective and safe drug and can be the first drug of choice for patients with extensive lymphangiectasis.
Collapse
Affiliation(s)
- Yiyoung Kwon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Eun Sil Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yon Ho Choe
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Mi Jin Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| |
Collapse
|
48
|
Neville JJ, Chacon CS, Jordan S, Roberton B, Semple T, Padley S, Clarke SA. Use of lymphangiography in neonates prior to thoracic duct ligation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
49
|
Hur J, Hur S, Shin JH, Kwon SH, Hyun D, Yoon J. Reversed Approach through Lymphocele/Lymphatic Fluid Collection for Glue Embolization of Injured Lymphatic Vessels. J Vasc Interv Radiol 2020; 32:299-304. [PMID: 33257108 DOI: 10.1016/j.jvir.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022] Open
Abstract
A total of 9 glue embolization procedures of injured lymphatic vessels with a reversed approach from the lymphocele/lymphatic fluid collection in 8 patients were retrospectively reviewed. The approach routes were via the indwelling chest tube for pleural effusion (n = 2), the drainage catheter tract for abdominopelvic lymphocele/lymphatic fluid collection/thigh lymphocele (n = 4), and the direct puncture of the lymphatic fluid collection at the operation bed (n = 2). All the procedures were technically successful without complications. The mean daily leakage rate decreased from 465 mL/d before the procedure to 42 mL/d after the procedure, and the drainage catheters could be removed after 8 procedures, achieving a clinical success rate of 88.9% (8 of 9 procedures).
Collapse
Affiliation(s)
- Joonho Hur
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Saebeom Hur
- Department of Radiology Seoul National University Hospital, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea.
| | - Se Hwan Kwon
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul, Korea
| | - Jehong Yoon
- Department of Radiology, Sahmyook Medical Center, Seoul, Korea
| |
Collapse
|
50
|
Pan F, Loos M, Do TD, Richter GM, Kauczor HU, Hackert T, Sommer CM. Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography. Eur Radiol Exp 2020; 4:60. [PMID: 33135104 PMCID: PMC7604276 DOI: 10.1186/s41747-020-00188-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/01/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To demonstrate the efficacy of percutaneous computed tomography (CT)-guided afferent lymphatic vessel sclerotherapy (ALVS) in the treatment of postoperative lymphatic leakage (LL) after ineffective therapeutic transpedal lymphangiography (TL). METHODS A retrospective review in this institute involving 201 patients was conducted from May 2011 to September 2018. Patients diagnosed with postoperative LL undergoing ineffective therapeutical TL before the performance of percutaneous CT-guided ALVS were involved. Technical success and clinical success of TL and ALVS were established. The technical success and efficacy of ALVS in the treatment of postoperative LL after ineffective therapeutic TL were assessed. The clinical success rate of ALVS is also assessed, and the complications are reviewed. RESULTS In total, nine patients were involved including three patients (33.3%) presented with chylothorax, three patients (33.3%) presented with inguinal lymphatic fistula/lymphocele, and three patients (33.3%) presented with lymphatic fistula in the thigh; 27 ± 18 days (mean ± standard deviation) after surgery, therapeutic TL was successfully performed and showed definite afferent lymphatic vessel and leakage site in all the patients. Due to clinical failure after TLs, the following ALVS was performed with a mean interval of 12 ± 8 days after TL. The technical success rate was 9/9 (100.0%, 95% confidence interval [CI] 63.1-100.0%). An average of 2.7 ± 1.3 mL 95% ethanol as sclerosant agent was injected during the procedure. The clinical success was observed in 8 of the 9 patients (88.9%, 95% CI 51.8-99.7%) with a time between ALVS and the LL cure of 8 ± 6 days. No complications were reported. CONCLUSIONS Our results showed the role of percutaneous CT-guided ALVS as a safe, feasible, and effective salvage treatment for postoperative LL after ineffective TL.
Collapse
Affiliation(s)
- F Pan
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M Loos
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - T D Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - G M Richter
- Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - C M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany. .,Clinic for Diagnostic and Interventional Radiology, Stuttgart Clinics, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
| |
Collapse
|