Clinical Use of Lymphangiography for Intractable Spontaneous Chylothorax

Ruan, Zehai; Zhou, Yi; Wang, S; J, Zhang; Wang, Y; Xu, Wenchao

doi:10.1055/s-0030-1271031

Cited by 6 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This classical white appearance is also noted in pseudochylothorax [35]. Lymphangiography could be used to identify the spot of the chyle leakage or blockage [35,36].…”

Section: Discussionmentioning

confidence: 93%

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

et al. 2015

View full text Add to dashboard Cite

Chylothorax is a rare form of chyle accumulation that can be associated with both traumatic and non-traumatic causes. We described a case of a patient who sustained a thoracic spine fracture-dislocation and presented with a left-sided chylothorax as a late complication to his thoracic spine trauma. A 19-year-old multi-trauma patient with bilateral pneumothorax, bilateral lung contusions and a severe thoracic spine fracture-dislocation was admitted to the intensive care unit (ICU) of our hospital intubated due to his unstable respiratory function. Bilateral thoracostomies were placed to his thoracic cavity prior to his admission to the ICU. The thoracic fracture-dislocation was stabilized with posterior fixation of his thoracic spine during his stay at the ICU. He was transferred to the neurosurgery department where at the 50th day of his hospitalization, a left-sided chylothorax was identified. Conservative management was decided and the chyle leak ceased over a period of 2 weeks. The patient was discharged from the clinic after a 3-month period of hospitalization. Traumatic chylothorax is a rare complication directly linked to thoracic spine fractures. It can occur immediately after trauma or several weeks after as in our case. Early diagnosis and treatment are essential for the avoidance of severe complications linked to the chyle loss.

show abstract

“…This classical white appearance is also noted in pseudochylothorax [35]. Lymphangiography could be used to identify the spot of the chyle leakage or blockage [35,36].…”

Section: Discussionmentioning

confidence: 93%

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Conventional lymphangiography is the gold standard for visualization of lymph nodes, lymphatic vessels, cisterna chyli, the thoracic duct, and sites of injury [14,22,23]. Lymphangiography alone has been shown to be therapeutic in a small percentage of patients, irrespective of attempts at TDE or disruption [24][25][26][27]. When performed as a prelude to TDE, the combination is particularly effective in treating traumatic chylothorax, with technical and clinical success rates approaching 90% [5][6][7][8][9]11].…”

Section: Discussion Of the Imaging Modalities By Variantmentioning

confidence: 99%

“…After securing the lymphatic access, 6 to 8 mL of ethiodized oil is instilled at a rate of 4 to 10 mL/h. Serial spot radiographs from the foot to the chest are acquired approximately every 10 to 15 minutes to follow the progression of the ethiodized oil as it ascends [22,[24][25][26][27].…”

Section: Overview Of Imaging Modalitiesmentioning

confidence: 99%

“…Lymphangiography is able to define the site of the leak, diagnose alternative lymphatic vessel diseases, and prevent unnecessary procedures. Several authors have documented the therapeutic benefit of lymphangiography to occlude the site of leakage in 37% to 70% of patients without additional procedures [24][25][26][27][28][29][30]. Moreover, as detailed earlier, lymphangiography is intrinsic to the performance of TDE and guides the transabdominal access to the cisterna chyli and thoracic duct [14][15][16].…”

Section: Overview Of Imaging Modalitiesmentioning

confidence: 99%

See 1 more Smart Citation

ACR Appropriateness Criteria ® Chylothorax Treatment Planning

Majdalany

Murrey

Kapoor

et al. 2017

Journal of the American College of Radiology

View full text Add to dashboard Cite

Chylothorax is an uncommon but serious medical condition, which arises when intestinal lymphatic fluid leaks into the pleural space. Treatment strategies depend on the daily output and underlying etiology, which may be due to direct injury to lymphatic vessels or a nontraumatic disorder. Chest radiographs confirm the presence of pleural fluid and lateralize the process. In the setting of direct injury, lymphangiography can often be both diagnostic and facilitate a minimally invasive attempt at therapy. CT and MRI in this setting may be appropriate for cases when lymphangiography is not diagnostic. When the etiology is nontraumatic or unknown, CT or MRI can narrow the differential diagnosis, and lymphangiography is useful if a minimally invasive approach to treatment is desired. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

show abstract

“…Ruan et al recommends lymphangiography in patients with intractable spontaneous chylothorax [17]. They found that this diagnostic procedure may facilitate the occlusion of the leakage site and the prediction of the occurrence of adverse events due to thoracic duct ligation.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy in the treatment of postoperative chylothorax

Sziklavári

Allgäuer

Hübner

et al. 2013

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundChylothorax is characterized by the presence of chyle in the pleural cavity. The healing rate of non-operative treatment varies enormously; the maximum success rate in series is 70%. We investigate the efficacy and outcomes of radiotherapy for postoperative chylothorax.MethodsChylothorax was identified based on the quantity and quality of the drainage fluid. Radiation was indicated if the daily chyle flow exceeded 450 ml after complete cessation of oral intake. Radiotherapy consisted of opposed isocentric portals to the mediastinum using 15 MV photon beams from a linear accelerator, a single dose of 1–1.5 Gy, and a maximum of five fractions per week. The radiation target area was the anatomical region between TH3 and TH10 depending on the localization of the resected lobe. The mean doses of the ionizing energy was 8.5 Gy ± 3.5 Gy.ResultsThe median start date of the radiation was the fourth day after chylothorax diagnosis. The patients’ mediastinum was radiated an average of six times. Radiotherapy, in combination with dietary restrictions, was successful in all patients. The median time between the end of the radiation and the removal of the chest tube was one day. One patient underwent wound healing by secondary intention. The median time between the end of radiation and discharge was three days, and the overall hospital stay between the chylothorax diagnosis and discharge was 18 days (range: 11–30 days). After a follow-up of six months, no patient experienced chylothorax recurrence.ConclusionsOur results suggest that radiotherapy in combination with dietary restriction in the treatment of postoperative chylothorax is very safe, rapid and successful. This novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays and could be the first choice in the treatment of postthoracotomy chylothorax.

show abstract

Clinical Use of Lymphangiography for Intractable Spontaneous Chylothorax

Cited by 6 publications

References 20 publications

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

ACR Appropriateness Criteria ® Chylothorax Treatment Planning

Radiotherapy in the treatment of postoperative chylothorax

Contact Info

Product

Resources

About