Thoracic duct embolization for the management of chylothoraces

Abstract

Recent advances in the lymphangiography techniques and the accumulation of experience in treating chylous effusions have significantly broadened the adoption of TDE to treat chylothorax. TDE for traumatic chylothorax has been demonstrated to be less morbid and more effective than surgical and conservative treatment. In cases of nontraumatic chylothorax, the patient has to be evaluated by MRI and lymphangiography to exclude causes of chylothorax which cannot be managed by interruption of the thoracic duct (e.g. lymphatic malformations or chylous ascites). Future advancements in noninvasive imaging of the thoracic duct and imaging guidance during TDE will continue to refine the percutaneous management of chylous effusions.

Percutaneous Lymphatic Embolization of Abnormal Pulmonary Lymphatic Flow as Treatment of Plastic Bronchitis in Patients With Congenital Heart Disease

“…After identification of the target vessel (larger lumbar lymphatics or cisterna chyli), access to this vessel was performed by using the transabdominal approach as previously described. 20 In short, the target lymphatic vessel was accessed through an anterior transabdominal approach using a 21-to 22-gauge Chiba needle (Cook Medical Inc, Bloomington, IN). A V18 control guide wire (Boston Scientific, Natick, MA) was then advanced into the TD and manipulated cephalad.…”

Nontraumatic Chylothorax: Diagnostic Algorithm and Treatment Options

“…Consequently, thorough understanding of the underlying lymphatic anatomy and flow patterns and identifying a possible leak source with imaging is often essential for planning an intervention and for interventional success. 16 This need for preintervention assessment of the lymphatic system has led to the development of MR lymphangiography techniques to classify the etiology of the chylothorax as well as the site of the leak. [6][7][8] As stated above, several disorders that originate as chylous ascites may present as chylothorax.…”

“…If at the end of the contrast injection the cysterna chyli was not visualized, the initial bolus was followed by injection of normal saline at 1 mL per 5 minutes to facilitate propagation of the contrast. 16,17 The lymphatic system is accessed and the TD cannulated as previously described. 18 At this point, additional non-oil based iodinated contrast may be injected to detail the flow and anatomy of the TD and any anomalies in the thorax.…”

Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis

“…Intranodal lymphangiogram was performed to opacify a target central lymphatic vessel. 7 Access to this vessel was then performed with a 22-gauge Chiba needle (Cook Medical Inc, Bloomington, Indiana) via a transabdominal approach. 7 A V18 control guide wire (Boston Scientific, Natick, Massachusetts) was advanced into the lymphatic duct and manipulated cephalad.…”

“…7 Access to this vessel was then performed with a 22-gauge Chiba needle (Cook Medical Inc, Bloomington, Indiana) via a transabdominal approach. 7 A V18 control guide wire (Boston Scientific, Natick, Massachusetts) was advanced into the lymphatic duct and manipulated cephalad. Over the wire, a 60-cm 2.3 F Rapid Transit microcatheter (Cordis Corp, Warren, New Jersey) was advanced further into the duct for imaging of the duct and its branches.…”