Thoracic Duct Ligation and Pericardectomy for Treatment of Idiopathic Chylothorax

Abstract

Chylothorax is a devastating disease, and the success rates from either medical or surgical management are less than satisfactory. In some animals with chylothorax, a thickening of the pericardium occurs that is associated with chronic irritation induced by chyle. We hypothesized that pericardial thickening would lead to increased right-sided venous pressures and that abnormal venous pressures would act to impede the drainage of chyle via lymphaticovenous communications after thoracic duct (TD) ligation. We also hypothesized that serosanguineous effusions that occurred after TD ligation could effectively be treated or prevented by pericardectomy in affected animals. TD ligation plus pericardectomy was performed in 17 animals, and pericardectomy alone was performed in an additional 3 animals that presented during a 5.5-year period to the Texas A&M University (College Station, TX). Nineteen animals presented for an evaluation of idiopathic chylothorax (9 dogs and 10 cats), and 1 dog presented for serosanguineous pleural fluid after TD ligation that had been performed elsewhere. Echocardiography was normal in all animals, except for a subjectively thickened pericardium in 7 cats and 6 dogs. Clinical signs of pleural fluid accumulation resolved in 10 of 10 dogs and in 8 of 10 cats after surgery. The overall success rate for the surgical treatment of chylothorax (ie, the resolution of pleural fluid accumulation) in this study was 90% (100% in dogs and 80% in cats). These data suggest that TD ligation in conjunction with pericardectomy has a favorable outcome in animals with idiopathic chylothorax.

Ruptura de conducto torácico idiopático en un gato: Reporte de caso

“…Várias etiologias podem desencadear a formação da efusão torácica desde causas compressivas até a ruptura dos vasos linfáticos, dentre elas doenças cardíacas, massas no mediastino cranial, trombose venosa, doenças fungicas granulomatosas, anormalidades congênitas, traumas, e as causas não identificáveis que recebem a denominação de quilotórax idiopático (Fossum et al, 2004). Segundo Squarcino et al (2007) a linfa apresenta importante função no sistema imune pois contem células do sistema mononuclear fagocitários, permitindo fagocitose de microrganismos patogênicos, produção de anticorpos, conservação das proteínas plasmática extravasadas dos capilares contribuindo para manutenção da pressão oncótica, e captação dos lipídeos originados da dieta.…”

“…Em Medicina Humana a taxa de sucesso com o tratamento clínico varia de 16-75%, sendo os pacientes que apresentam menor volume drenado e com etiologia de trauma, os responsáveis por melhores desfechos. Ressalva-se que as toracotomias para redução do acúmulo de quilo são medidas apenas paliativas dos sinais clínicos, garantindo melhoria sistêmica e conforto ao paciente (Fossum et al, 2004, Mohammad et al, 2017.…”

Visualisation of the thoracic duct after popliteal lymph node injection in the pig: comparison of radiographic and thoracoscopic techniques

“…Visualisation of the TD was obvious in five out of nine patients (those where 240 mg/ml iohexol was used at 37°C). Taken together, in cases where cannulation of an abdominal lymph vessel was used, the success rate with contrast media or with MB seems to be higher regardless of the animal species (Radlinsky et al 2002;Fossum et al 2004;Leasure et al 2011). However, since the catheterisation of an abdominal lymph vessel is a demanding procedure that requires an open approach to the abdominal cavity, our study aimed to evaluate alternative techniques.…”

“…Because the observed resolution rates with conservative management are low, surgery is usually preferred. Current surgical management of chylothorax consists of the following: TD ligation (Fossum et al 1986;Fossum et al 1991); partial pericardiectomy with or without TD ligation (Fossum et al 2004;Carobbi et al 2008); clipping of the TD during thoracoscopy (Radlinsky et al 2002); clipping or sealing of the TD and pericardiectomy during thoracoscopy (Allman et al 2010;Haimel et al 2012); cisterna chyli ablation with or without TD ligation (Hayashi et al 2005;Sakals et al 2011); omentalisation with or without TD ligation (Williams and Niles 1999;Talavera et al 2009;Stewart and Padgett 2010); or pleurodesis (Radlinsky 2012).…”

Computed Tomography and Radiographic Lymphography of the Thoracic Duct by Subcutaneous or Submucosal Injection

“…To date, surgical treatment of chylothorax has included thoracic duct ligation [2], pleuroperitoneal shunting [11], thoracic omentalization [8], cisterna chyli ablation [6] and pericardiectomy [5], either alone or in combination with thoracic duct ligation. Thoracic duct ligation is recommended as the 1st choice among these methods [3,5]. One possible cause for the failure of thoracic duct ligation and subsequent recurrence is the occurrence mistakes in the surgery itself, such as failure to tie all of the complex tributaries into which the thoracic duct divides [1].…”