Ultrasound-guided lymphangiography and interventional embolization of chylous leaks following esophagectomy

Abstract

ObjectivesPostoperative chylothorax is a serious complication after transthoracic esophagectomy, and is associated with major morbidity due to dehydration and malnutrition. For patients with high-output fistula, re-thoracotomy with ligation of the thoracic duct is the treatment of choice. Radiologic interventional management is an innovative procedure that has the potential to replace surgery in the treatment algorithm.MethodsFour patients with high-output chylous leaks following esophagectomy are presented. Ultrasound-guided lymphangiography with embolization of the thoracic duct and/or disruption of the cisterna chyli was performed to occlude the leakage site. Radiologic interventions and procedure-related outcomes are described in detail.ResultsIn all four patients, ultrasound-guided lymphangiography of the groin with injection of Lipiodol was able to detect and visualize the leakage site in the lower mediastinum. In three patients, the leak could be successfully occluded by Lipiodol embolization. In one patient, embolization failed and the disruption technique was successfully performed. No procedure-related complications were observed.ConclusionsIn case of a postoperative chylothorax, radiologic intervention is feasible and safe. The procedure is indicated for high-output chylous fistulas after esophagectomy, and should be applied early after the diagnosis of this postoperative complication.

Chylothorax and mediastinal haematoma by central venous catheter post-duodenal ulcer and pyloroplasty surgery: a case report

“…Lymphangiography and lymphoscintigraphy are useful in identifying major lymphatic leaks. 9 Yet, a few cases reported in this study revealed no significant contrast leak and the location of the leakage could not be pinpointed. Another possible explanation for chylothorax is accumulation of PN into the pleural cavities through the extravasated CVC tip.…”

An Unusual Cause of Chylothorax after Esophagectomy

“…1 ) and subsequent c-arm visualization of the site of leak from the thoracic duct. 6 To our surprise, we found that the thoracic duct was opacifying well up to the site of the clip in the thorax, but without any leak from it. The only leak that could be demonstrated was a minor one in the left subdiapghramatic location from an adjacent lymphatic tributary ( Fig.…”

Thoracic Duct Embolization for Delayed Chyle Leak After Lewis-Tanner Esophagectomy

“…Traditionally, conservative management based on dietary modification (fat-free diet) and drainage is the first-line treatment for low output (<1000 mL/day) of chylothorax. Some studies suggest the adjuvant use of somatostatin analogs, such as octreotide and etilefrine, with or without pleurodesis [ 16 , 17 ]. Wemyss et al [ 4 ] based the therapeutic approach on daily drain output.…”