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Thoracic duct embolization

Shuji Kariya, Miyuki Nakatani, Rie Yoshida, Yutaka Ueno, Atsushi Komemushi, Noboru Tanigawa
PURPOSE: This study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route. METHODS: Data were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery...
October 14, 2016: Cardiovascular and Interventional Radiology
Maxim G Itkin, Francis X McCormack, Yoav Dori
RATIONALE: Plastic bronchitis is a condition characterized by expectoration of branching bronchial casts. Although the mechanism of cast formation in adults with plastic bronchitis remains poorly understood, abnormal pulmonary lymphatic flow resulting in molding of congealing lymphatic fluids in the airway has been documented as a cause of the disease in children with congenital heart disease. OBJECTIVES: To use advanced lymphatic imaging techniques, including dynamic contrast-enhanced magnetic resonance (MR) lymphangiography (DCMRL) and intranodal lymphangiography, to investigate the mechanism of cast formation in adult patients with plastic bronchitis, and to evaluate the therapeutic outcome of percutaneous lymphatic embolization for these patients...
October 2016: Annals of the American Thoracic Society
Carlos J Guevara, Kristy L Rialon, Raja S Ramaswamy, Seung K Kim, Michael D Darcy
PURPOSE: To describe technical details, success rate, and advantages of direct puncture of the thoracic duct (TD) under direct ultrasound (US) guidance at venous insertion in the left neck. MATERIALS AND METHODS: All patients who underwent attempted thoracic duct embolization (TDE) via US-guided retrograde TD access in the left neck were retrospectively reviewed. Indications for lymphangiography were iatrogenic chyle leak, pulmonary lymphangiectasia, and plastic bronchitis...
August 29, 2016: Journal of Vascular and Interventional Radiology: JVIR
Rodrigo Gobbo Garcia, Rafael Dahmer Rocha, Juliana Franceschini, Mário Cláudio Ghefter, Breno Boueri Affonso, Antônio Rahal, Priscila Mina Falsarella, Felipe Nasser, Ricardo Sales Dos Santos
Postoperative chylous leak is often a consequence of thoracic duct injury during surgical procedures. Persistent chylothorax can be an extremely morbid condition. The authors describe a case of a refractory and long-standing chylous leak after thoracotomy for mediastinal lymphangioma removal. The patient was treated with a computed tomography-guided percutaneous thoracic duct sclero-embolization after failure of the conventional therapies. The chest tube output abruptly decreased after the procedure and was removed at 13th day...
July 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Maxim Itkin
No abstract text is available yet for this article.
August 2016: Journal of Vascular and Interventional Radiology: JVIR
Kagami Miyaji
Between, 2000 and 2015, for 200 patients video-assisted thoracic surgery (VATS)-patent ductus arteriosus (PDA) has been performed, including 130 infants and children, and 70 low birth weight babies. Robotically assisted procedure was used in 105 patients. The mean age was 10 months, and body weight was 5.3 kg, ranged from 420 g to 61 kg. The mean procedure time was 48 min, ranged from 20 to 180 min. The size of PDA was around 5 mm in diameter. Conversion to thoracotomy was 4 cases. There were 2 haspital deaths(1...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
M Atie, G Dunn, G L Falk
INTRODUCTION: Chyle leak after oesophagectomy is highly morbid and may carry significant mortality if treatment is delayed. Identification of the site of leakage and surgery may be plagued by failure. PRESENTATION OF CASE: We describe a case of chyle leak after oesophagectomy. Lymphangiography revealed the site of chyle leak to be an aberrant duct that would have been difficult to identify surgically. Radiological coiling and embolization successfully treated the leak...
2016: International Journal of Surgery Case Reports
Oren W Johnson, Jeffrey Forris Beecham Chick, Nikunj Rashmikant Chauhan, Alexandra Holmsen Fairchild, Chieh-Min Fan, Michael S Stecker, Timothy P Killoran, Alisa Suzuki-Han
UNLABELLED: The thoracic duct is the body's largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the thoracic duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes...
August 2016: European Radiology
Nicola Martucci, Maura Tracey, Gaetano Rocco
Chylothorax is an unusual but serious complication of thoracic surgical procedures, and may carry considerable morbidity if not addressed in a timely fashion. Thoracic surgeons should be able to promptly diagnose this complication, and understand the implications of prolonged chyle loss to the patient. Conservative measures are often successful; direct intervention with percutaneous embolization of the cisterna chyli or thoracoscopic ligation is reserved for refractory cases. Some controversy exists regarding the timing of reintervention to limit the accumulated chyle loss...
November 2015: Thoracic Surgery Clinics
Grzegorz Buła, Ryszard Mucha, Michał Paliga, Witold Truchanowski, Jacek Gawrychowski
UNLABELLED: The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF) while treated surgically for a goiter. MATERIAL AND METHODS: A total of 3810 patients were treated for goiters between 2008 to 2013. Symptoms of postoperative ARF were recognized in 39 (1%) patients. RESULTS: Symptoms of postoperative ARF were a postoperative hemorrhage in 31 (79.4%), lymphorrhagia in 1 (2...
July 1, 2015: Polski Przeglad Chirurgiczny
Hasan Dinç, Şükrü Oğuz, Ahmet Sarı
Lymphangiography and percutaneous embolization of injured lymphatics are minimally invasive and effective techniques for the diagnosis and treatment of thoracic and retroperitoneal lymphatic leaks. We present a 58-year-old man who had abdominal chylous collection developed after multiple abdominal surgeries. Retroperitoneal lymphatic duct leakage was detected by ultrasound-guided intranodal lymphangiography and treated successfully using computed tomography (CT)-guided transabdominal embolization with percutaneous N-butyl cyanoacrylate (NBCA) glue and percutaneous NBCA glue and coil embolization by directly catheterizing the leaking lymphatic channel through the chylous collection...
September 2015: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Inderpal S Sarkaria, David J Finley, Manjit S Bains, Prasad S Adusumilli, Nabil P Rizk, James Huang, Robert J Downey, Valerie W Rusch, David R Jones
OBJECTIVE: Although the technical aspects of robotic video-assisted thoracic surgery (RVATS) for lung resections may be advantageous, compared with standard thoracoscopy, complications of chylothorax and recurrent laryngeal nerve injury (RLNI) associated with mediastinal lymph node dissection (MLND) may be significant. METHODS: Consecutive patients who underwent RVATS anatomic lung resection for suspected or confirmed cancer and experienced RLNI or chylothorax were identified and reviewed from a prospectively maintained database...
May 2015: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Yasuhiro Shirakawa, Kazuhiro Noma, Toshiaki Ohara, Hajime Kashima, Naoaki Maeda, Shunsuke Tanabe, Shunsuke Kagawa, Toshiyoshi Fujiwara
A chyle leak can occur as a complication after neck or chest surgery. Such a leak prolongs the hospital stay and is sometimes life-threatening. The treatment options are conservative management, interventional radiologic embolization, and surgery. Thoracoscopic ligation of the thoracic duct has emerged as a promising and definitive treatment. The case of a 65-year-old Japanese male patient with a rare congenital right aortic arch (typeⅢB1 of Edward's classification) and a severe chyle leak that occurred after a total pharyngolaryngo-esophagectomy (TPLE) is described...
2015: Acta Medica Okayama
H H Schild, C P Naehle, K E Wilhelm, C K Kuhl, D Thomas, C Meyer, J Textor, H Strunk, W A Willinek, C C Pieper
PURPOSE: To determine effectiveness of lymphatic interventional procedures for treatment of chylothorax. MATERIAL AND METHODS: Analysis of interventions performed from 2001 to 2014. RESULTS: In 21 patients with therapy resistant chylothorax a lymphatic radiological intervention was attempted, which could be performed in 19 cases: 17 thoracic duct embolizations (15 transabdominal, one transzervical and one retrograde transvenous procedure), 2 percutaneous destructions of lymphatic vessels, one CT-guided injection of ethanol next to a duplicated thoracic duct...
July 2015: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Kwang Hyoung Lee, Jae Seung Jung, Sung Bum Cho, Seung Hun Lee, Hee Jung Kim, Ho Sung Son
Chylothorax is a rare postoperative complication of a thoracic surgical procedure. Here, we report a case of chylothorax after thoracic endovascular aortic repair with debranching for the distal arch aneurysm of the aorta. First, the patient was treated by a medical method (nil per os, fat-free diet, and octreotide), but this method failed. The patient strongly refused surgical treatment. Therefore, we tried to occlude the thoracic duct by lymphangiography Lipiodol, and this line of treatment was successful...
February 2015: Korean Journal of Thoracic and Cardiovascular Surgery
L Lampl
In order to achieve a minimal complication rate there is a need for a comprehensive strategy. This means in the first line preventive steps which include patient positioning, suitable approaches and access, an appropriately qualified surgical team as well as a carefully planned dissection and preparation. Furthermore, a supply of additional instrumentation, such as thrombectomy catheters, special vascular clamps and even extracorporeal membrane oxygenation (ECMO) and a heart-lung machine (HLM) in cases of centrally located lesions should be on stand-by...
May 2015: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
Edward Wolfgang Lee, Ji Hoon Shin, Heung Kyu Ko, Jihong Park, Soo Hwan Kim, Kyu-Bo Sung
In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization...
November 2014: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Juan C Lopez-Gutierrez, Juan A Tovar
Leakage of lymph from the lymphatic ducts causes chylothorax (CT) or chylous ascitis (CA). This may happen for unknown reasons during fetal life or after birth and may also be caused by trauma after thoracic surgery or by other conditions. Fetal CT and CA may be lethal particularly in cases with fetal hydrops that sometimes benefit of intra-uterine instrumentation. After birth, symptoms are related to the amount of accumulated fluid. Sometimes, severe cardio-respiratory compromise prompts active therapy. Most patients with CT or CA benefit from observation, rest, and supportive measures alone...
October 2014: Seminars in Pediatric Surgery
Malachi Courtney, Raj R Ayyagari
Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization...
June 2015: Pediatric Radiology
Kyle J Marthaller, Stephen P Johnson, Robert M Pride, Erick R Ratzer, Harris W Hollis
BACKGROUND: Post-esophagectomy patients who develop high-output chylous fistula and chylothorax can be successfully treated with percutaneous ablation thereby avoiding reoperation. METHODS: Five patients with refractory chylous fistula post-esophagectomy were treated with percutaneous embolization. Fistula outputs, evaluation of lymphatic access sites, agents used and additional procedures were analyzed. RESULTS: Successful ablation of the chylous fistula was achieved in 4 of the 5 (80%) patients...
February 2015: American Journal of Surgery
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