The effectiveness of lymphangiography as a treatment method for various chyle leakages

Matsumoto, Tomohiro; Yamagami, Takuji; Kato, Takeshi; Hirota, Tatsuya; Yoshimatsu, Rika; Masunami, T; Nishimura, Tsunehiko

doi:10.1259/bjr/64849421

Cited by 197 publications

(158 citation statements)

References 20 publications

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“…Recently published reports indicate that lymphangiography plays a therapeutic role in patients with lymphatic leakage. 16 In our case, although lymphangiography was not performed, scintigraphy and α-1-antitrypsin clearance showed lymphatic leakage and obvious improvement with treatment. However, there were no changes in the enteroscopic findings after treatment.…”

Section: Figurementioning

confidence: 50%

Everolimus for Primary Intestinal Lymphangiectasia With Protein-Losing Enteropathy

et al. 2016

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Primary intestinal lymphangiectasia (PIL), also known as Waldmann’s disease, is an exudative enteropathy resulting from morphologic abnormalities in the intestinal lymphatics. In this article, we describe a 12-year-old boy with PIL that led to protein-losing enteropathy characterized by diarrhea, hypoalbuminemia associated with edema (serum albumin level: 1.0 g/dL), and hypogammaglobulinemia (serum IgG level: 144 mg/dL). Severe hypoalbuminemia, electrolyte abnormalities, and tetany persisted despite a low-fat diet and propranolol. Everolimus (1.6 mg/m2/day) was added to his treatment as an antiangiogenic agent. With everolimus treatment, the patient’s diarrhea resolved and replacement therapy for hypoproteinemia was less frequent. Hematologic and scintigraphy findings also improved (serum albumin level: 2.5 g/dL). There were no adverse reactions during the 12-month follow-up. To the best of our knowledge, this is the first report of everolimus use in a patient with PIL.

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Section: Figurementioning

confidence: 50%

Everolimus for Primary Intestinal Lymphangiectasia With Protein-Losing Enteropathy

et al. 2016

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“…6) Matsumoto et al stated that 89% of patients with postoperative chylothorax avoid surgical intervention after lymphography. 7) As an other percutaneous intervention, thoracic duct embolization was reported by Chen et al 8) A microcatheter is inserted into the thoracic duct and embolization of thoracic duct was achieved with microcoils and Truefill glue. We performed lipiodol lymphography in our patient and successfully treated his chylothorax, which was intractable for several already known conservative treatments.…”

Section: Discussionmentioning

confidence: 99%

Management of Aortic Replacement-Induced Chylothorax by Lipiodol Lymphography

Kuwabara

Yoshitake

Hachiya

et al. 2015

Annals of Vascular Diseases

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A 39-year-old man was admitted to our hospital for aortic surgery for a remaining descending aortic dissected aneurysm. He previously underwent emergency total arch replacement for the treatment of ascending aortic dissection Stanford type A 5 years ago. Physical examination and laboratory data revealed no remarkable findings. Computed tomography (CT) detected a 70-mm-diameter descending aortic aneurysm. Descending aortic replacement was performed following posterolateral thoracotomy. Venoarterial bypass was established by femoral venous and arterial cannulation. Intraoperatively, the adhesion around the lung and aneurysm was not dense. The descending aortic replacement was carried out using a 28-mm-diameter woven graft. Surgery was completed uneventfully with no significant bleeding. One day postoperatively, hoarseness developed. A nasogastric tube was then inserted and enteral nutrition was initiated. Non-fat diet was given because the amount of pleural drainage was higher than the usual 300 mL/day, with a suspicion of chylothorax. Subsequently, the pleural drainage started to decrease. Thereafter, a fat-included diet was started on postoperative day 6, changing the pleural effusion to chyle. Chylothorax was confirmed by chemical analysis indicating triglyceride in the pleural drainage (1325 mg/dL) and blood (295 mg/dL). Oral intake cessation and total parenteral nutrition through a central venous catheter were started. As the factor XIII activity was 46%, factor XIII products were administered at 20 mL/day for 5 days. However, pleural effusion remained after these treatments. To specifically identify the location of and reduce the chyle leakage, lipiodol lymphography was attempted in the supine position through bilateral inguinal lymph nodes. A 23-G needle was inserted to the inguinal lymph nodes, followed by the injection of 7 mL of lipiodol in the right lymph node and 8 mL in the left lymph node (Fig. 1). Thirty minutes later, CT scan detected the location of the chyle leakage in the pleural cavity near the distal anastomosis (Fig. 2). Two days after this procedure, the amount of pleural effusion decreased. Following chest Chylothorax is a rare but serious complication of thoracic aortic surgery, leading to malnutrition, respiratory insufficiency, and prolonged hospital stay. In this article, we describe the successful treatment of a case of intractable chylothorax by lipiodol lymphography. The patient was a 39-year-old man who underwent descending aortic replacement for a remaining dissected aneurysm after total arch replacement. Chylothorax developed postoperatively. After complete oral intake cessation, total parenteral nutrition, and plasmatic factor XIII administration, lipiodol lymphography detected the chyle leakage location and subsequently decreased pleural effusion. The patient recovered uneventfully and was discharged on postoperative day 30 without any complications.

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“…Patients with bilateral lymphatic fistulas could be cured by unilateral operation probably because of self-healing of the fistula after PLG. The mechanism might have been peri-lymph duct inflammation caused by the contrast agents or an embolism effect of the oily contrast agents [9,10]. …”

Section: Discussionmentioning

confidence: 99%

The Advantages of Unilateral Pedal Lymphography in the Diagnosis of Chyluria

Liu

He²,

Zhou³

et al. 2014

Urol Int

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Objectives: To evaluate the efficacy and safety of pedal lymphography (PLG) in the localization diagnosis of chyluria. Methods: Cystoscopy was performed in 153 patients and PLG in 121 cases. Unilateral or staged bilateral ligation and stripping of renal lymphatic vessel were performed according to the results of cystoscopy and/or PLG. Results: Unilateral and bilateral urinary excretion of chyle was detected in 123 and 1 case by cystoscopy, respectively. In 121 cases receiving PLG, 100 cases of unilateral fistulous connection between the renal pelvis and the lymphatic system, 18 cases of bilateral fistulas and 1 case of lymphatic bladder fistula were demonstrated. PLG has a higher diagnostic rate for the detection of bilateral lymphatic renal pelvis fistulas than cystoscopy (p < 0.05). 28 cases received renal pedicle lymphatic disconnection only according to the results of cystoscopy, and 3 of them failed (10.1%). While 121 cases had the same operation according to the results of PLG, only 1 case failed the operation (0.8%). Conclusions: PLG was efficient and safe for the localization diagnosis of chyluria, with a higher detection rate of bilateral fistulas than cystoscopy. PLG might benefit the selection of appropriate therapy and improve the surgical effect.

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The effectiveness of lymphangiography as a treatment method for various chyle leakages

Cited by 197 publications

References 20 publications

Everolimus for Primary Intestinal Lymphangiectasia With Protein-Losing Enteropathy

Everolimus for Primary Intestinal Lymphangiectasia With Protein-Losing Enteropathy

Management of Aortic Replacement-Induced Chylothorax by Lipiodol Lymphography

The Advantages of Unilateral Pedal Lymphography in the Diagnosis of Chyluria

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