New application of direct lymphangiography in the diagnosis and treatment of chylothorax after lung cancer surgery: a case series

An, Ran; Song, Xuejiao; Sun, Yue; Chang, Kun; Li, Yiyin; Shen, Wenbin

doi:10.21037/apm-21-263

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…Lymphangiography, not yet adopted at our center, was not included in this study’s treatment approach. It serves not only for diagnosis but also as a therapeutic method ( 39 ). Elevated levels of triglycerides in pleural fluid and a high pleural fluid triglyceride/serum triglyceride ratio indicate positive lymphangiography in patients with chylothorax ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of related factors and treatment effect of chylothorax after lung surgery

Zhu,

Feng,

Huang

et al. 2024

J Thorac Dis

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Background Chylothorax is a seldom encountered complication following lung surgery. However, due to the widespread practice of lung surgery, postoperative complications have inevitably arisen. Chylothorax significantly affects a patient’s discharge and recovery. This study investigates the risk factors for postoperative chylothorax at our center and analyzes various treatment modalities and prognostic outcomes. Methods A retrospective analysis was conducted on all postoperative lung resections performed between January 2018 to August 2021 that met the inclusion criteria. Inclusion criteria covered patients undergoing various thoracic surgeries for lung conditions, while exclusion criteria included postoperative referrals for surgeries unrelated to lung tumors. Results Postoperative chylothorax occurred in 42 of 5,706 patients after lung surgery. General information and disease-related data of the chylothorax and control group were analyzed by univariate and multivariate analyses. Multivariate analysis showed that serum albumin before surgery [odds ratio (OR) =0.86, 95% confidence interval (CI): 0.81–0.91, P<0.001], γ-glutamyl transferase level before surgery (after logarithmic transformation, OR =1.01, 95% CI: 1.00–1.01, P=0.01), squamous cell carcinoma (OR =2.77, 95% CI: 1.37–5.6, P=0.008), right mediastinal lymph node dissection (OR =3.15, 95% CI: 1.62–6.14, P<0.001) were independent risk factors for postoperative chylothorax. Among the 42 cases of postoperative chylothorax, 26 patients were improved with conservative treatments, and 6 patients were improved with chemical pleurodesis. Eight patients with postoperative chylothorax underwent thoracoscopic thoracic duct ligation. Three patients experienced severe postoperative complications: one was discharged after prolonged treatment, while the remaining two either succumbed or were discharged against medical advice. Conclusions The incidence of chylothorax after lung surgery closely correlates with the intraoperative trauma and nutritional status of patients during the perioperative period. The majority of patients with postoperative chylothorax experienced relief through conservative measures, somatostatin administration, and chemical pleurodesis. Nevertheless, substantial postoperative chylothorax necessitated surgical intervention, involving thoracic duct ligation or drug pleurodesis.

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Section: Discussionmentioning

confidence: 99%

Analysis of related factors and treatment effect of chylothorax after lung surgery

Zhu,

Feng,

Huang

et al. 2024

J Thorac Dis

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“…The TD can be injured via trauma, surgery, or congested by central venous occlusion (An et al 2021 ; Chick et al 2018 ). It may be caused by compression from outside.…”

Section: Discussionmentioning

confidence: 99%

Management of chyluria using percutaneous thoracic duct stenting

Cương

Linh

et al. 2022

CVIR Endovasc

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Background Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. Case presentation Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion. Conclusion This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.

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“…The TD can be injured via trauma, surgery, or central venous occlusion [7,8]. It may be caused by compression from outside.…”

Section: Discussionmentioning

confidence: 99%

Successful management of chyluria using percutaneous thoracic duct stenting

Cương

Linh

et al. 2022

Preprint

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Background Chyluria is defined as the presence of chyle in the urine that is caused by chylous reflux through the communication between the lymphatic system and the urinary tract. Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. There are only few case reports about thoracic duct stenting in the literature. Case presentation: Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent and the patient was successful treated with thoracic duct stenting. Conclusions This report demonstrates the feasibility, effective of using thoracic duct stenting in the treatment chyuria due to lymphovenous junction obstruction.

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New application of direct lymphangiography in the diagnosis and treatment of chylothorax after lung cancer surgery: a case series

Cited by 4 publications

References 22 publications

Analysis of related factors and treatment effect of chylothorax after lung surgery

Analysis of related factors and treatment effect of chylothorax after lung surgery

Management of chyluria using percutaneous thoracic duct stenting

Successful management of chyluria using percutaneous thoracic duct stenting

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