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Thoracic duct embolization

Ruud S Kootte, Joost D E Haeck, Krijn P van Lienden, Wim J P van Boven, Allard C van der Wal, Hans H de Boer
A 68-year-old woman, previously treated with embolization of the thoracic duct with Lipiodol (an ethiodized oil injection) and cyanoacrylate glue (a topical tissue adhesive), was admitted with an asymptomatic mass in the inferior vena cava (IVC) and right atrium. The mass was surgically removed, and pathologic analysis revealed a Lipiodol-containing thrombus. To our knowledge, this is the first clinicopathologic report of Lipiodol-induced thrombus presenting as an intracavitary mass.
March 2017: Annals of Thoracic Surgery
Michael Yannes, Donghoon Shin, Kevin McCluskey, Rakesh Varma, Ernesto Santos
PURPOSE: To evaluate clinical success and time to resolution of intranodal lymphangiography (INL) alone or with thoracic duct embolization (TDE) or thoracic duct disruption (TDD) based on initial effusion volume for postsurgical chylothorax. MATERIALS AND METHODS: Retrospective review was performed of 57 patients (mean age 63 y; 65% male) undergoing INL alone or in conjunction with other percutaneous techniques for postsurgical chylous effusions. INL alone was performed when chylothorax output was ≤ 500 mL/d and no leak was identified during fluoroscopy...
February 3, 2017: Journal of Vascular and Interventional Radiology: JVIR
Maxim Itkin
Pulmonary lymphatic diseases have been recognized for many years and have been referred as pulmonary lymphangiectasia, pulmonary lymphangiomatosis, plastic bronchitis, and idiopathic chylothorax or chylopericardium. The lymphatic etiology of these conditions has been determined by detection of cystic lymphatic structures on biopsy or postmortem examination. Development of new imaging techniques such as dynamic contrast-enhanced magnetic resonance lymphangiography has allowed better understanding of pathophysiology of these conditions...
December 2016: Techniques in Vascular and Interventional Radiology
Jinoo Kim, Je Hwan Won
Chylous ascites occurs as a result of lymphatic leakage, which contains high concentration of triglycerides. The leakage is caused by various benign or malignant etiologies ranging from congenital lymphatic abnormality to trauma. Lymphangiography has been shown to be effective in the diagnosis of lymphatic leakage and has also been reported to have therapeutic outcome. The development of intranodal technique for lymphangiography has recently made the procedure more widespread. As an adjunctive procedure, percutaneous embolization may be performed which involves use of embolic agents such as N-butyl cyanoacrylate and coil to occlude the leak...
December 2016: Techniques in Vascular and Interventional Radiology
Gregory Nadolski
Nontraumatic chylothorax is a relatively rare condition in which the intestinal lymph (chyle) leaks into the pleural cavity. Nontraumatic chylothorax is more difficult to treat than the more common traumatic chylothorax because the site of chylous leak may occur in less predictable locations. In the past, patients with nontraumatic chylothoraces were offered traditional fluoroscopically guided lymphangiography and thoracic duct embolization similar to traumatic chylothorax. However, the observation that thoracic duct embolization outcomes for nontraumatic chylothorax differed based on the imaging findings during lymphangiography has led to the development of a treatment algorithm, which incorporates noninvasive diagnostic studies, such as magnetic resonance lymphangiography...
December 2016: Techniques in Vascular and Interventional Radiology
Michael S Stecker, Chieh-Min Fan
Lymph leaks resulting in chylous pleural effusions can be life-threatening. Minimally invasive thoracic duct embolization and disruption have been gaining acceptance as first-line treatment for these leaks. This review discusses the techniques for both pedal and intranodal lymphangiography in detail. It also discusses the use of lymphangiography as a means of targeting a retroperitoneal lymphatic to facilitate thoracic duct interventions for chyle leaks. Finally, outcomes and adverse events pertaining to these thoracic duct interventions are discussed...
December 2016: Techniques in Vascular and Interventional Radiology
Masanori Inoue, Seishi Nakatsuka, Hideki Yashiro, Masashi Tamura, Yohsuke Suyama, Jitsuro Tsukada, Nobutake Ito, Sota Oguro, Masahiro Jinzaki
Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions...
November 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
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...
January 2017: 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...
December 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
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