Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Abstract

Objective: To preliminarily explore the safety and effectiveness of transpedal lymphangiography (TL) with high-dose ethiodized oil application (>20 ml) in the treatment of high-output postoperative chylothorax.Methods: From 1 July 2020 to 1 July 2021, a total of 7 patients with high-flow postoperative chylothorax (> 1,000 ml/d) were retrospectively reviewed in a single center. Clinical data, including surgery types, technical and treatment success of TL, and adverse events of TL, were collected and analyzed.Results: Seven patients (5 cases of non-small cell lung cancer; 2 cases of esophageal carcinoma) with a median age of 62 years (range: 30–70 years) occurred postoperative chylothorax after tumor resection with mediastinal lymphadenectomy. All patients received conservative treatment including total parenteral nutrition and somatostatin administration for a median of 20 days (range: 15–31 days) that failed to cure the chylothorax, so TL was performed as a salvage. Before TL, the median daily chyle output was 1,500 ml/day (range: 1,100–2,000 ml/day). The technical success rate of TL was 100% (7/7), with the median volume of ethiodized oil of 27.6 ml (range: 21.2–30.0 ml) injected in TL. Ruptured thoracic duct was identified in 5 patients (5/7, 71%) in fluoroscopy and chest CT after TL. The treatment success rate of TL was 86% (6/7). In 6 patients, the thoracic drainage was removed after a median of 7 days (range: 4–13 days) from TL performance. No adverse event of TL was reported.Conclusion: Transpedal lymphangiography with high-dose ethiodized oil application (>20 ml) is a feasible, safe, and effective modality for the treatment of high-flow (> 1,000 ml/day) postoperative chylothorax.

Standardizing lymphangiography and lymphatic interventions: a preclinical in vivo approach with detailed procedural steps

“…This histological structure provides a basis for interstitial lymphangiography. Interstitial injection of water-soluble contrast media that can easily permeate into the lymphatic capillaries, such as the dye "Patent Blue V" and gadoliniumbased magnetic resonance contrast agents, to achieve the visualization of the lymphatic structures under direct vision or radiological imaging (Mazzei et al 2017;Pieper et al 2019;Pieper et al 2020;Li et al 2021, Pan, Richter et al 2022. In this review, we attempted to test the feasibility of lymphangiography by interstitial injection of lipiodol, an oily contrast agent that is difficult to pass the lymphatic wall.…”

“…The interstitial dye test can be used not only for the optical visualization of subcutaneous lymphatic vessels and lymph nodes before lymphangiography but also for the indirect identification of PLL (Pieper et al 2019;Li et al 2021, Pan, Richter et al 2022. Lymphatic vessels can be demonstrated visually following the interstitial injection of a diffusible dye, such as Patent Blue V (100 mg/4 ml, Guerbet, Roissy, France), which is the most satisfactory lymphatic dye.…”

“…It is typically introduced prior to the traditional translymphatic lymphangiography (e.g., transpedal) in humans or intranodal lymphangiography in rabbits (Matsumoto et al 2019;Pieper et al 2019;Pan et al 2020a, b, c, Pan, Richter et al 2022. A positive result of the interstitial dye test is one of the main diagnostic criteria of PLL (Pan et al 2020a, b, c;Li et al 2021, Pan, Richter et al 2022.…”

Iodine-Induced Hypothyroidism After Chemoembolization With Ethiodized Oil: A Case of Failure to Escape From Wolff-Chaikoff Effect (WCE)

“…Lipidiol® can be used to approach recurrent chylothorax [ 17 - 18 ]. This nonionic low osmolar ICM is an ethiodized oil injection for intralymphatic, intrauterine, and selective hepatic intra-arterial use only [ 19 ].…”

Invasive treatment of persistent postoperative chylothorax secondary to thoracic duct variation injury: Two case reports and literature review

“…[ 13 ] Fluoroscopic lymphangiography also plays a therapeutic role for chylothorax with a clinical success rate of 73% to 95%. [ 13 , 14 ] Due to the inflammatory and embolic reaction of lipiodol, it usually takes a relative long time to treat the chylous leakage. From our perspective, a month maybe needed to observe the treatment effect.…”