Explore the vast range of titles available.

Objectives To evaluate clinical outcomes of thoracic duct embolization (TDE) for the management of postoperative chylothorax with the aid of the bail-out retrograde approach for thoracic duct cannulation (TDC). Materials and methods Forty-five patients with postoperative chylothorax underwent Lipiodol lymphangiography (LLG) between February 2016 and November 2019. If targetable central lymphatic vessels were identified in LLG, TDC, a prerequisite for TDE, was attempted. While the conventional antegrade transabdominal approach was the standard TDC method, the retrograde approach was applied as a bail-out method. Embolization, the last step of TDE, was performed after confirming leakages in the trans-TDC catheter lymphangiography. Technical and clinical success rates were determined retrospectively. Results TDC was attempted in 40 among 45 patients based on LLG findings. The technical success rate of TDC with the conventional antegrade approach was 78% (31/40). In addition, six more patients were cannulated using the bail-out retrograde approach, which raised the technical success rate to 93% (37/40). While 35 patients underwent embolization (TDE group), ten patients did not (non-TDE group) for the following reasons: (1) lack of targetable lymphatics for TDC in LLG (n = 5), (2) technical failure of TDC (n = 3), and (3) lack of discernible leakages in the transcatheter lymphangiography (n = 2). The clinical success of the TDE group was 89% (31/35), compared with 50% (5/10) of the non-TDE group. One major procedure-related complication was bile peritonitis caused by the needle passage of the distended gallbladder. Conclusions Bail-out retrograde approach for TDC could improve the overall technical success of TDC significantly. Key Points • Bail-out retrograde thoracic duct access may improve the overall technical success of thoracic duct access, thus improving the clinical success of thoracic duct embolization .

In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization.

Objectives To define the roles of noncontrast magnetic resonance lymphangiography (MRL) in the management of postoperative chylothorax or cervical chylous leakage. Methods A total of 50 consecutive patients underwent noncontrast MRL, intranodal lymphangiography, and thoracic duct embolization between May 2016 and April 2020. Their mean age was 62.6 years ± 10.3 (SD) years, and 35 of the participants were men. Conventional lymphangiographic images were sufficient in quality as a reference for the evaluation of diagnostic accuracy of leakage and location in 35 patients (70%) and for evaluation of anatomic details of the thoracic duct and jugulovenous junction in 34 patients (68%). Results MRL showed that the sensitivity, specificity, and positive and negative predictive values for leakage detection were 100%, 97.1%, 100%, and 100%, respectively, and the concordance rate was 97.14% (95% confidence interval [CI], 85.08–99.93%; p  <  . 001). Leakage location was concordant between MRL and conventional lymphangiography in 27 patients (77.1%, 27/35). Regarding anatomical details of the thoracic duct, variation of the thoracic duct was missed in 11.7% of patients (4/34). The jugulovenous junction was observed in 91.1% (31/34), and its opening into the central vein was depicted in 76.4% (26/34). The concordance rate was between 76.47 and 91.18. Conclusions Noncontrast MRL has a high sensitivity for the detection of postoperative thoracic and cervical chylous leakage but is suboptimal for the localization of the leak and depiction of anatomical details of the thoracic duct. This method is worthy of consideration as either a decision-making or planning tool for subsequent interventions. Key Points • Noncontrast MRL provides limited resolution images of CLS but has a high sensitivity for the detection of postoperative chylous leakage in the thoracic and neck regions. • Noncontrast MRL is suboptimal for depicting anatomic details in the thoracic duct and jugulovenous junction but can play a role as a decision-making and a planning tool for subsequent lymphatic interventions.

To assess the role and treatment response of percutaneous lymphatic embolization performed for non-traumatic chylothorax in patients with Gorham-Stout disease (GSD) with regard to thoracic duct embolization (TDE) and embolization of pleural or lymphatic collaterals. This retrospective single-institution study included consecutive patients who underwent percutaneous lymphatic embolization between January 2013 and December 2022. The patients underwent dynamic contrast-enhanced magnetic resonance lymphangiography, fluoroscopic intranodal lymphangiography, or both to evaluate the lymphatic anatomy prior to the intervention. The patients underwent TDE, pleural lymphatic embolization, or both, depending on the imaging findings. The data collected included imaging findings, procedural details, and clinical outcomes (clinical success was defined as removal of the drainage catheter without re-accumulation of effusion or improvement in clinical symptoms). Five male patients (aged 5-29 years) with chylothorax (n = 3) or hemorrhagic chylothorax (n = 2) were included. The key imaging findings included giant thoracic duct (n = 3) and dilated parietal pleural lymphatic system (n = 5). Twelve embolization sessions were performed (median, 2 sessions per patient; range 1-4 sessions). The embolized lymphatic structures included the thoracic duct (n = 4), parietal pleural lymphatics (n = 4), and other lymphatic collaterals (n = 3). The embolic agents used were glue and coils (n = 3), and glue only (n = 2). TDE alone achieved clinical success in only 25% of the cases (1 out of 4). With additional embolization of the parietal pleural lymphatics and other collaterals, clinical success was achieved in 80% of the cases (4 out of 5). One patient developed chylous ascites after the TDE. Percutaneous lymphatic embolization targeting the thoracic duct and pleural lymphatic collaterals is a feasible treatment option for GSD-related chylothorax.

To report outcomes, procedure and fluoroscopy times, and adverse event rates after intranodal lymphangiography (IL) and modified IL (mIL) for treatment of traumatic chylous leaks in the thorax and neck. Under an IRB-approved protocol, retrospective review of a quality assurance database identified all lymphangiograms for post-surgical refractory chylous leaks in the thorax and neck at a tertiary center from 2002-2022. Records were reviewed for technical and clinical outcomes, procedure and fluoroscopy times, and adverse events. Pedal lymphangiograms were excluded. Patients were categorized into IL (pre-2016) and mIL (post-2016) cohorts. mIL incorporated pneumatic calf compression throughout the procedure. Technical success was defined as successful thoracic duct cannulation. Clinical success was defined as leak resolution and eventual chest or other drain removal within 2 weeks post-procedure. A two-tailed Fischer's exact test was used to compare categorical outcomes. A two-tailed t test was used to compare means. Two hundred and thirty-nine patients underwent 263 thoracic duct embolizations of traumatic chylous leaks in the thorax/neck. Intranodal lymphangiography was used in 167 cases in 150 patients. Overall clinical success was 94.6% [n = 142/150]. Technical success was higher in mIL (94.2% [81/86]) than IL (76.5% [62/81]) (p = 0.002). Clinical success per patient and procedure were similar between cohorts (92.3% [72/78] mIL versus 97.2% [70/72] IL, p = 0.27, and 83.7% [72/86] mIL versus 85.1% [69/81] IL, p = 0.83, respectively). Mean procedure time in mIL (83.4 ± 31.9 min) was shorter than in IL (119.2 ± 45.9 min) (p < 0.0001). Mean fluoroscopy time in mIL (33.8 ± 17.3 min) was shorter than in IL (41.7 ± 23.2 min) (p = 0.02). Adverse event rate was not significantly different between groups. Overall, thoracic duct embolization for traumatic chylothorax has high clinical success, approaching 95%. While clinical success of mIL was similar to IL, technical success and mean procedure and fluoroscopic times were significantly improved. Findings suggest modified intranodal lymphangiography should be utilized to treat traumatic chylothorax. Level 4, Case Series.

Surgery is an effective treatment for chylothorax, particularly in cases of high-output chylothorax. However, precisely locating the thoracic duct for ligation and observing the surgical outcomes intraoperatively remains a challenge for surgeons. In this study, we demonstrated the feasibility of using Near-infrared (NIR) fluorescence imaging for thoracic duct ligation following indocyanine green (ICG) injection. Five patients with chylothorax who underwent surgery at our center were retrospectively included in this study. Of these, two had postoperative chylothorax following esophageal cancer surgery, one had postoperative chylothorax following lung cancer surgery, and two had spontaneous chylothorax. All patients received inguinal lymph node injections of ICG and subsequently underwent thoracic duct ligation under NIR-guided video-assisted thoracoscopic surgery (VATS) after anesthesia. All patients underwent NIR-guided ICG injection followed by VATS thoracic duct ligation. Four patients were operated on via the right side and one via the left side. The mean operative time was 62 min, the mean SBR value was 4.19, the mean postoperative drainage was 229.6 ml/day, the mean duration of postoperative chest drainage was 6.2 days, and the mean hospital stay was 17.8 days. None of the patients experienced recurrence of chylothorax postoperatively or during follow-up. In conclusion, NIR combined with ICG injection is highly effective in exploring and exposing the thoracic duct, as well as in determining the surgical outcome of thoracic duct ligation in real time.