Download PDF
Semin intervent Radiol 2020; 37(03): 263-268
DOI: 10.1055/s-0040-1713443
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Traumatic Chylothorax: Approach and Outcomes

Shenise N. Gilyard
1   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Minhaj S. Khaja
2   Division of Vascular and Interventional Radiology, Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
,
Abhishek K. Goswami
1   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Nima Kokabi
1   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
,
Wael E. Saad
3   Division of Vascular and Interventional Radiology, Department of Radiology, National Institutes of Health, Bethesda, Maryland
,
Bill S. Majdalany
1   Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
› Author Affiliations
Further Information

Publication History

Publication Date:
31 July 2020 (online)

Also available at
    Permissions and Reprints

Abstract

Traumatic chylothorax occurs more often now than in historic reports. In part, this is due to the increased ability to perform more advanced and aggressive thoracic resections and cardiovascular surgeries as well as the improved mortality of cancer patients. If untreated, chylothorax can result in significant morbidity and mortality, particularly in patients with underlying malignancy. Thoracic duct embolization for chylothorax was the first successful lymphatic intervention and has been performed for over 20 years. An overview of the clinical and technical approach to thoracic duct embolization for traumatic chylothorax is presented in addition to a review of outcomes.

Keywords

chylothorax - thoracic duct embolization - iatrogenic - traumatic - postoperative - interventional radiology

Disclosures

All authors have read and contributed to this manuscript. The authors have no relevant disclosures. There was no grant funding or financial support for this manuscript.


 

  • References

  • 1 Maldonado F, Hawkins FJ, Daniels CE, Doerr CH, Decker PA, Ryu JH. Pleural fluid characteristics of chylothorax. Mayo Clin Proc 2009; 84 (02) 129-133
    CrossrefPubMedSearch in Google Scholar
  • 2 Merigliano S, Molena D, Ruol A. , et al. Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg 2000; 119 (03) 453-457
    CrossrefPubMedSearch in Google Scholar
  • 3 Majdalany BS, Murrey Jr DA, Kapoor BS. , et al; Expert Panel on Vascular Imaging and Interventional Radiology. ACR Appropriateness Criteria® chylothorax treatment planning. J Am Coll Radiol 2017; 14 (5S) S118-S126
    CrossrefPubMedSearch in Google Scholar
  • 4 Doerr CH, Allen MS, Nichols III FC, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005; 80 (07) 867-870
    CrossrefPubMedSearch in Google Scholar
  • 5 Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH. Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci 2010; 339 (04) 314-318
    CrossrefPubMedSearch in Google Scholar
  • 6 Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg 2007; 32 (02) 362-369
    CrossrefPubMedSearch in Google Scholar
  • 7 Cope C, Salem R, Kaiser LR. Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial. J Vasc Interv Radiol 1999; 10 (09) 1248-1254
    CrossrefPubMedSearch in Google Scholar
  • 8 Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol 2002; 13 (11) 1139-1148
    CrossrefPubMedSearch in Google Scholar
  • 9 Aalami OO, Allen DB, Organ Jr CH. Chylous ascites: a collective review. Surgery 2000; 128 (05) 761-778
    CrossrefPubMedSearch in Google Scholar
  • 10 Breslin JW, Yang Y, Scallan JP, Sweat RS, Adderley SP, Murfee WL. Lymphatic vessel network structure and physiology. Compr Physiol 2018; 9 (01) 207-299
    CrossrefPubMedSearch in Google Scholar
  • 11 Platis IE, Nwogu CE. Chylothorax. Thorac Surg Clin 2006; 16 (03) 209-214
    CrossrefPubMedSearch in Google Scholar
  • 12 Nix JT, Albert M, Dugas JE, Wendt DL. Chylothorax and chylous ascites; a study of 302 selected cases. Am J Gastroenterol 1957; 28 (01) 40-53 , discussion, 53–55
    PubMedSearch in Google Scholar
  • 13 Savla JJ, Itkin M, Rossano JW, Dori Y. Post-operative chylothorax in patients with congenital heart disease. J Am Coll Cardiol 2017; 69 (19) 2410-2422
    PubMedSearch in Google Scholar
  • 14 Oshikiri T, Takiguchi G, Miura S. , et al. thoracic duct resection during esophagectomy does not contribute to improved prognosis in esophageal squamous cell carcinoma: a propensity score matched-cohort study. Ann Surg Oncol 2019; 26 (12) 4053-4061
    CrossrefPubMedSearch in Google Scholar
  • 15 Bao T, Wang YJ, Li KK, Liu XH, Guo W. Short- and long-term outcomes of prophylactic thoracic duct ligation during thoracoscopic-laparoscopic McKeown esophagectomy for cancer: a propensity score matching analysis. Surg Endosc 2019; ; [Epub ahead of print]
    CrossrefPubMedSearch in Google Scholar
  • 16 Hung WT, Hung MH, Wang ML, Cheng YJ, Hsu HH, Chen JS. Nonintubated thoracoscopic surgery for lung tumor: seven years' experience with 1,025 patients. Ann Thorac Surg 2019; 107 (06) 1607-1612
    CrossrefPubMedSearch in Google Scholar
  • 17 Wu D, Chesnokova AE, Akvan S. , et al. Postoperative chylothorax after thoracoabdominal aortic aneurysm repair. Semin Thorac Cardiovasc Surg 2018; 30 (02) 215-219
    CrossrefPubMedSearch in Google Scholar
  • 18 Cope C. Percutaneous thoracic duct cannulation: feasibility study in swine. J Vasc Interv Radiol 1995; 6 (04) 559-564
    CrossrefPubMedSearch in Google Scholar
  • 19 Cope C. Percutaneous transabdominal embolization of thoracic duct lacerations in animals. J Vasc Interv Radiol 1996; 7 (05) 725-731
    CrossrefPubMedSearch in Google Scholar
  • 20 Rajebi MR, Chaudry G, Padua HM. , et al. Intranodal lymphangiography: feasibility and preliminary experience in children. J Vasc Interv Radiol 2011; 22 (09) 1300-1305
    CrossrefPubMedSearch in Google Scholar
  • 21 Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 2012; 23 (05) 613-616
    CrossrefPubMedSearch in Google Scholar
  • 22 Meisinger QC, O'Brien S, Itkin M, Nadolski GJ. Use of sequential pneumatic compression devices to facilitate propagation of contrast during intranodal lymphangiography. J Vasc Interv Radiol 2017; 28 (11) 1544-1547
    CrossrefPubMedSearch in Google Scholar
  • 23 Mittleider D, Dykes TA, Cicuto KP, Amberson SM, Leusner CR. Retrograde cannulation of the thoracic duct and embolization of the cisterna chyli in the treatment of chylous ascites. J Vasc Interv Radiol 2008; 19 (2, Pt 1): 285-290
    CrossrefPubMedSearch in Google Scholar
  • 24 Guevara CJ, Rialon KL, Ramaswamy RS, Kim SK, Darcy MD. US-guided, direct puncture retrograde thoracic duct access, lymphangiography, and embolization: feasibility and efficacy. J Vasc Interv Radiol 2016; 27 (12) 1890-1896
    CrossrefPubMedSearch in Google Scholar
  • 25 Majdalany BS, Khayat M, Sanogo ML, Saad WE, Khaja MS. Direct trans-cervical endolymphatic thoracic duct stent-graft for plastic bronchitis. Lymphology 2018; 51 (03) 97-101
    PubMedSearch in Google Scholar
  • 26 Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 2010; 139 (03) 584-589 , discussion 589–590
    CrossrefPubMedSearch in Google Scholar
  • 27 Pamarthi V, Stecker MS, Schenker MP. , et al. Thoracic duct embolization and disruption for treatment of chylous effusions: experience with 105 patients. J Vasc Interv Radiol 2014; 25 (09) 1398-1404
    CrossrefPubMedSearch in Google Scholar
  • 28 Yannes M, Shin D, McCluskey K, Varma R, Santos E. Comparative analysis of Intranodal Lymphangiography with percutaneous intervention for postsurgical chylous effusions. J Vasc Interv Radiol 2017; 28 (05) 704-711
    CrossrefPubMedSearch in Google Scholar
  • 29 Kim PH, Tsauo J, Shin JH. Lymphatic interventions for chylothorax: a systematic review and meta-analysis. J Vasc Interv Radiol 2018; 29 (02) 194-202.e4
    CrossrefPubMedSearch in Google Scholar
  • 30 Majdalany BS, Saad WA, Chick JFB, Khaja MS, Cooper KJ, Srinivasa RN. Pediatric lymphangiography, thoracic duct embolization and thoracic duct disruption: a single-institution experience in 11 children with chylothorax. Pediatr Radiol 2018; 48 (02) 235-240
    CrossrefPubMedSearch in Google Scholar
  • 31 Laslett D, Trerotola SO, Itkin M. Delayed complications following technically successful thoracic duct embolization. J Vasc Interv Radiol 2012; 23 (01) 76-79
    CrossrefPubMedSearch in Google Scholar