Recurrent Left Cervical Swelling and Chylothorax due to Lymphatic Thrombosis

Vach, Marius; Attenberger, Ulrike; Pieper, Claus Christian

doi:10.1007/s00270-020-02659-3

Cited by 3 publications

(12 citation statements)

References 5 publications

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“…This occurs or is aggravated in the context of physical stress, minor trauma or strain in the head/neck region (e.g., during sport, yoga), as also seen in our patients. 3 , 4 Prior local disease, surgery or radiation therapy may be predisposing like other conditions that obstruct the normal lymph flow (e.g., thoracic outlet syndrome). The swelling subsides over time, but recurs with symptom‐free intervals between 5 days and 7 weeks in our patients.…”

Section: Discussionmentioning

confidence: 99%

“…In most patients, the swelling is accompanied by dyspnea, which besides the sudden and inexplicable onset, is usually the patients' main concern. 4 Whether dyspnea is due to the space occupying effect of the edema, due to larynx involvement, or results from accompanying pleural effusion (often presumed to be chylothorax) can only be speculated. Although pleural effusions have been described to accompany a swelling attack in a number of cases, 1 , 3 our imaging results demonstrate, that effusions are not necessarily present during every swelling episode.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, recurrent or intermittent cervical swelling—sometimes referred to as recurrent cervical swelling syndrome (RCS)—is a rare condition. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Patients are usually concerned because of sudden onset and the inexplicable occurrence of symptoms. 4 …”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Patients are usually concerned because of sudden onset and the inexplicable occurrence of symptoms. 4 …”

Section: Introductionmentioning

confidence: 99%

“…Recently, however, recurrent swelling episodes have been linked to lymphatic disorders such as lymph vessel obstruction. 3 , 4 So in cases with a typical history, the diagnostic work‐up should focus on the lymphatic system to detect anomalies that may predispose to ruptures of lymph vessels with leakage or pathological reflux of lymph. However, diagnosis of lymphatic flow pathologies is challenging.…”

Section: Introductionmentioning

confidence: 99%

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MR‐lymphangiography identifies lymphatic pathologies in patients with idiopathic recurrent cervical swelling

Vach

Wagenpfeil

Henkel

et al. 2022

Laryngoscope Investig Oto

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Background Idiopathic recurrent cervical swelling may be caused by lymphatic abnormalities. Methods Ten patients (9 females, mean age 51.2 ± 7) with idiopathic recurrent cervical swelling underwent MR‐lymphangiography (MRL). MR‐lymphangiograms were evaluated regarding lymphatic anatomy and flow. Individualized treatment was recommended according to MRL‐findings. Results 8/10 patients presented with left‐sided, 2/10 with right‐sided swelling. Pathological lymph‐flow was identified in all cases: thoracic duct dilatation in patients with left‐sided and right lymphatic duct dilatation in right‐sided swelling, accessory thoracic lymphatics in 7/10 and reflux in 8/10 cases. In two cases, a lymphatic thrombus was identified. After treatment, symptoms resolved completely in 6/10 cases and partially in 1/10 cases. The remaining three patients have intermittent swellings but have no treatment wish. Conclusion Idiopathic recurrent cervical swelling can be caused by lymphatic anomalies. MRL displays impaired lymphatic drainage, lymphatic vessel dilatation, and chylolymphatic reflux as hallmarks of this condition and may aid in targeted treatment planning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Patients are usually concerned because of sudden onset and the inexplicable occurrence of symptoms. 4 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

MR‐lymphangiography identifies lymphatic pathologies in patients with idiopathic recurrent cervical swelling

Vach

Wagenpfeil

Henkel

et al. 2022

Laryngoscope Investig Oto

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The right lymphatic duct: basic anatomy and clinical relevance

Kanavaros,

Karatzias,

Papoudou-Bai

et al. 2024

Vasa

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Summary: The anatomical variability of the thoracic duct and the right lymphatic duct predisposes them to inadvertent damage following head and neck surgery thereby leading to chyle leak which is an uncommon complication with potentially significant associated morbidity. Although chyle leak is predominately associated with left-sided neck surgery, it also occurs as a complication of the right-sided neck dissection. Variable figures concerning chyle leakage after right-sided neck dissections were reported, ranging from 0 per cent to higher prevalences such as 14%, 24%, 33% and 60% of total cases of chyle leakages associated with neck surgery. The right-sided complications may implicate the right lymphatic duct and right-sided terminations of the thoracic duct into the venous system which occur in about 1-6% of humans. Other clinically relevant conditions involving the right-sided major lymphatic vessels include chyle leaks following right anterior cervical spine surgery, cysts of the right lymphatic duct and dilatation of the right lymphatic duct in the setting of recurrent cervical swelling. This article presents a review of the literature concerning the basic anatomy and the clinical relevance of the right lymphatic duct and the right-sided terminations of the thoracic duct into the venous circulation.

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Back to the Future II—A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions

Pieper

2023

Invest Radiol

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Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.

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Recurrent Left Cervical Swelling and Chylothorax due to Lymphatic Thrombosis

Cited by 3 publications

References 5 publications

MR‐lymphangiography identifies lymphatic pathologies in patients with idiopathic recurrent cervical swelling

MR‐lymphangiography identifies lymphatic pathologies in patients with idiopathic recurrent cervical swelling

The right lymphatic duct: basic anatomy and clinical relevance

Back to the Future II—A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions

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