Thorac Cardiovasc Surg 2011; 59(7): 430-435
DOI: 10.1055/s-0030-1271031
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Clinical Use of Lymphangiography for Intractable Spontaneous Chylothorax

Z. Ruan1 , 2 , Y. Zhou1 , S. Wang2 , J. Zhang3 , Y. Wang1 , W. Xu4
  • 1Department of Thoracic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
  • 2Department of Thoracic Surgery, The First Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China
  • 3Department of Radiology, The First Affiliated People's Hospital, Shanghai Jiao Tong University, Shanghai, China
  • 4Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
Further Information

Publication History

received July 28, 2010 revised Sept. 6, 2010

accepted October 4, 2010

Publication Date:
09 May 2011 (online)

Abstract

Objectives: Aim of this study was to discuss the clinical value of lymphangiography for intractable spontaneous chylothorax. Methods: From 2002 to 2009, 15 cases of intractable spontaneous chylothorax underwent lymphangiography in two institutions. Patient history, imaging data, therapeutic options and follow-up were recorded and retrospectively analyzed. Results: Twelve cases had successful lymphangiography while lymphangiography failed in the other 3 cases. No procedure-related complications occurred. Lymphangiography was useful for the diagnosis of lymphatic vessel disease and underlying disease in 6 (50 %) cases, but the etiology in the remaining 6 cases (50 %) remained uncertain. Signs of leakage or contrast extravasation were directly detected in 5 (42 %) patients. Based on the lymphangiography findings, 5 cases underwent surgical intervention with satisfactory results, with one recurrence 5 years later. Two patients had steatorrhea and chyluria after successful thoracic duct ligation. Seven cases were treated conservatively, 5 of whom were cured while the other 2 cases had temporary remission of symptoms. Conclusions: Lymphangiography can help to diagnose lymphatic vessel disease and underlying diseases, localize the leakage site for surgical therapy and prevent unnecessary surgical interventions. It may also play a role in occluding the leakage site and predicting the occurrence of adverse events due to thoracic duct ligation. We recommend lymphangiography in patients with intractable spontaneous chylothorax.

Reference

  • 1 Wemyss-Holden S A, Launois B, Maddern G J. Management of thoracic duct injuries after oesophagectomy.  Br J Surg. 2001;  88 (11) 1442-1448
  • 2 Dugue L, Sauvanet A, Farges O et al. Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy.  Br J Surg. 1998;  85 (8) 1147-1149
  • 3 Romero S. Nontraumatic chylothorax.  Curr Opin Pulm Med. 2000;  6 (4) 287-291
  • 4 Guermazi A, Brice P, Hennequin C et al. Lymphography: an old technique retains its usefulness.  Radiographics. 2003;  23 (6) 1541-1558
  • 5 Kos S, Haueisen H, Lachmund U et al. Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage.  Cardiovasc Intervent Radiol. 2007;  30 (5) 968-973
  • 6 Ngan H, Fok M, Wong J. The role of lymphography in chylothorax following thoracic surgery.  Br J Radiol. 1988;  61 (731) 1032-1036
  • 7 Barrett T, Choyke P L, Kobayashi H. Imaging of the lymphatic system: new horizons.  Contrast Media Mol Imaging. 2006;  1 (6) 230-245
  • 8 Maldonado F, Cartin-Ceba R, Hawkins F J et al. Medical and surgical management of chylothorax and associated outcomes.  Am J Med Sci. 2010;  339 (4) 314-318
  • 9 Noel A A, Gloviczki P, Bender C E et al. Treatment of symptomatic primary chylous disorders.  J Vasc Surg. 2001;  34 (5) 785-791
  • 10 Porziella V, Cesario A, Margaritora S et al. Role of pre-operative lymphangiogram and lympangioscintigraphy in the surgical management of spontaneous chylothorax.  Eur J Cardiothorac Surg. 2006;  30 (5) 813
  • 11 Matsumoto T, Yamagami T, Kato T et al. The effectiveness of lymphangiography as a treatment method for various chyle leakages.  Br J Radiol. 2009;  82 (976) 286-290
  • 12 Nair S K, Petko M, Hayward M P. Aetiology and management of chylothorax in adults.  Eur J Cardiothorac Surg. 2007;  32 (2) 362-369
  • 13 McGrath E E, Blades Z, Anderson P B. Chylothorax: aetiology, diagnosis and therapeutic options.  Respir Med. 2010;  104 (1) 1-8
  • 14 Christodoulou M, Ris H B, Pezzetta E. Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax.  Eur J Cardiothorac Surg. 2006;  29 (5) 810-814
  • 15 Boffa D J, Sands M J, Rice T W et al. A critical evaluation of a percutaneous diagnostic and treatment strategy for chylothorax after thoracic surgery.  Eur J Cardiothorac Surg. 2008;  33 (3) 435-439
  • 16 Patterson G A, Todd T R, Delarue N C et al. Supradiaphragmatic ligation of the thoracic duct in intractable chylous fistula.  Ann Thorac Surg. 1981;  32 (1) 44-49
  • 17 Park J H, Kim S H, Han J K et al. Transcatheter arterial embolization of unresectable renal cell carcinoma with a mixture of ethanol and iodized oil.  Cardiovasc Intervent Radiol. 1994;  17 (6) 323-327
  • 18 Tateishi H, Oi H, Masuda N et al. Appraisal of combination treatment for hepatocellular carcinoma: long-term follow-up and lipiodol-percutaneous ethanol injection therapy.  Semin Oncol. 1997;  24 (2 Suppl. 6) S6-S81-S6-S90
  • 19 Yamagami T, Masunami T, Kato T et al. Spontaneous healing of chyle leakage after lymphangiography.  B J Radiol. 2005;  78 (933) 854-857
  • 20 Tiemtaoure B, Gahide G, Casteigt J et al. Lymphography, a therapeutic possibility for a surgical wound of the thoracic canal: a case study.  J Radiol. 2007;  88 (1 pt 1) 69-71
  • 21 Su I C, Chen C M. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review.  Eur Spine J. 2007;  16 (Suppl. 3) 332-337
  • 22 Raguse J D, Pfitzmann R, Bier J et al. Lower-extremity lymphedema following neck dissection – an uncommon complication after cervical ligation of the thoracic duct.  Oral Oncol. 2007;  43 (8) 835-837
  • 23 Le Pimpec-Barthes F, Pham M, Jouan J et al. Peritoneoatrial shunting for intractable chylous ascites complicating thoracic duct ligation.  Ann Thorac Surg. 2009;  87 (5) 1601-1603
  • 24 Robinson K, Weinstein E S, Langsfeld M. Bilateral chylothorax following thoracic duct ligation: case report and review of the literature.  Ann Vasc Surg. 1996;  10 (4) 390-395
  • 25 De Freitas V, Zorzetto N L, Prates J C et al. Experimental study of lymphatico-venous communications after thoracic duct ligature in dogs.  Anat Anz. 1979;  146 (1) 27-38

Dr. Zheng Ruan, MD

Department of Thoracic Surgery
Tongji Hospital
Tongji University School of Medicine

No. 389, XinCun Road

Shanghai 200065

China

Phone: +86 21 66 11 14 35

Fax: +86 21 66 10 30 27

Email: thoracicsurgeon@126.com