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Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions. Percutaneous TD embolization-comprising access to the TD followed by embolization-has recently become a minimally invasive alternative to surgical TD ligation for high-output chylothorax. The selection of access routes to the TD depends on its anatomy. If the TD cannot be approached by such means, other options include TD needle interruption or drainage of lymphatic fluid adjacent to the leakage point followed by sclerotherapy. Most cases of abdominal lymphorrhea arise from the aorta-iliac lymphatic system, and lymphangiography alone or computed tomography-guided sclerotherapy might be useful. Rarely, leakage may arise from hepatic lymphatics due to a damaged gastroduodenal ligament and can be visualized and embolized transhepatically. This article comprehensively reviews clinically relevant anatomic TD variations, lymphangiography techniques and criteria for their selection, and treatment strategies for lymphorrhea. RSNA, 2016.

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MRI-guided prostate biopsy in conventional closed-bore scanners requires transferring the patient outside the bore during needle insertion due to the constrained in-bore space, causing a safety hazard and limiting image feedback. To address this issue, we present our custom-made in-bore setup and software to support MRI-guided transperineal prostate biopsy in a wide-bore 3 Tesla (T) MRI scanner. The setup consists of a specially designed tabletop and a needle-guiding template with Z-frame that give a physician access to the perineum of the patient at the imaging position and allow performance of MRI-guided transperineal biopsy without moving the patient out of the scanner. The software and Z-frame allow registration of the template, target planning, and biopsy guidance. Initially, we performed phantom experiments to assess the accuracy of template registration and needle placement in a controlled environment. Subsequently, we embarked on our clinical trial (N = 10). The phantom experiments showed that the translational errors of the template registration along the right-left (RP) and anterior-posterior (AP) axes were 1.1 ± 0.8 mm and 1.4 ± 1.1 mm respectively, while the rotational errors around the RL, AP, and superior-inferior axes were 0.8 ± 1.0 degrees, 1.7 ± 1.6 degrees, and 0.0 ± 0.0 degrees respectively. The 2D root-mean-square (RMS) needle placement error was 3.0 mm. The clinical biopsy procedures were safely carried out in all ten clinical cases with a needle placement error of 5.4 mm (2D RMS). In conclusion, transperineal prostate biopsy in a wide-bore 3T scanner is feasible using our custom-made tabletop set up and software, which supports manual needle placement without moving the patient out of the magnet.