Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

Journal of Cardiothoracic Surgery

Jian-Xin Shi²  Yuan Shao³  Ding-Yi Liu¹ 

[1] Department of Urology, Shanghai Pu-nan Hospital, 2400, South Pudong Road, Shanghai 200125, China;Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200040, China;Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai 200025, China

关键词: Thoracic duct;    Unilateral;    Lymphangiography;    Idiopathic chylothorax;   

Others  :  812037
DOI  :  10.1186/1749-8090-9-8

 received in 2013-08-12, accepted in 2013-12-30,  发布年份 2014

【 摘 要 】

Purpose

To identify the value of unilateral pedal lymphangiography (LAG) with non-contrast CT in the location and treatment decision of idiopathic chylothorax after failure of thoracic duct ligation.

Materials and Methods

Twenty four patients aged 9–84 year old (median 44 yr) who had idiopathic chylothorax were involved, and unilateral pedal LAG with non-contrast CT was performed in every patient. All patients failed to previous right supra-diaphragmatic thoracic duct ligation.

Results

The amount of iodized oil used was 6–14 ml with no related complications. LAG demonstrated 8 patients with thoracic duct leaks and 10 patients with leaks elsewhere, but no visible chylous leak in 6 patients. Ligation of thoracic duct was performed as the primary treatment in all 8 cases as having thoracic duct leakage and cured 7(87.5%) patients. For 8 patients not having thoracic duct lesion under LAG, the successful rate of thoracic duct ligation was 25% (2 out of 8 patients), which was significantly lower than patients due to thoracic duct lesions (P = 0.02). Meanwhile, non-operative therapy had significantly higher successful rate (87.5% vs 25%, P = 0.02).

Conclusions

Unilateral pedal LAG with non-contrast CT could identify the causes and locate the leaks of idiopathic chylothorax in 75% of patients after failure of thoracic duct ligation. Two thirds of patients were found not to have thoracic duct leakage and would be better managed by non-operative treatment.

【 授权许可】

   
2014 Liu et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Doerr CH, Allen MS, Nicholas FC 3rd, et al.: Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005, 80:867-870.
• [2]Valentine VG, Raffin TA: The management of chylothorax. Chest 1992, 102:586-591.
• [3]Merrigan BA, Winter DC, O’Sullivan GC: Chylothorax. Br J Surg 1997, 84:15-20.
• [4]Guermazi A, Brice P, Hennequin C, et al.: Lymphography: an old technique retains its usefulness. Radiographics 2003, 23:1541-1558.
• [5]Yamagami T, Masunami T, Kato T, et al.: Spontaneous healing of chyle leakage after lymphangiography. Br J Radiol 2005, 78:854-857.
• [6]Matsumoto T, Yamagami T, Kato T, et al.: The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol 2009, 82:286-290.
• [7]Kos S, Haueisen H, Lachmund U, et al.: Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Intervent Radiol 2007, 30:968-973.
• [8]Deso S, Kabutey N-K, Vilvendhan R, et al.: Lymphangiography in the diagnosis, localization, and treatment of a lymphaticopelvic fistula causing chyluria: a case report. Vasc Endovascular Surg 2010, 44:710-713.
• [9]Browse NL, Allen DR, Wilson NM: Management of chylothorax. Br J Surg 1997, 84:1711-1716.
• [10]Koga S, Nagata Y, Arakaki Y, et al.: Unilateral pedal lymphography in patients with filarial chyluria. BJU Int 2000, 85:222-223.
• [11]Baulieux J, Rode A, Chalret Du Rieu M, et al.: Management of postoperative chylothorax. J Visc Surg 2011, 148(5):e346-52.
• [12]Noel AA, Gloviczki P, Bender CE, et al.: Treatment of symptomatic primary chylous disorders. J Vasc Surg 2001, 34:785-791.
• [13]Cambria RA, Gloviczki P, Naessens JM, et al.: Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semiquantitative analysis in 386 extremities. J Vasc Surg 1993, 18:773-782.
• [14]Zelmanovitz F: Location of regional intestinal lymphangiectasia using Tc-99 m dextran lymphoscintigraphy. Clin Nucl Med 1999, 24:210-211.
• [15]Lohrmann C, Foeldi E, Speck O, Langer M: High-resolution MR lymphangiography in patients with primary and secondary lymphedema. AJR Am J Roentgenol 2006, 187:556-561.
• [16]Arrive L, Azizi L, Lewin M, et al.: MR lymphography of abdominal and retroperitoneal lymphatic vessels. AJR Am J Roentgenol 2007, 189:1051-1058.
• [17]Alejandre-Lafont E, Krompiec C, Rau WS, et al.: Effectiveness of therapeutic lymphography on lymphatic leakage. Acta Radiol 2011, 52:305-311.
• [18]Kusumoto S, Imamura A, Watanabe K: Case report: the incidental lipid embolization to the brain and kidney after lymphography in a patient with malignant lymphoma: CT findings. Clin Radiol 1991, 44:279-280.
• [19]Winterer JT, Blum U, Boos S, et al.: Cerebral and renal embolization after lymphography in a patient with non-Hodgkin lymphoma: case report. Radiology 1999, 210:381-383.
• [20]Dupont H, Timsit JF, Souweine B, et al.: Intra-alveolar hemorrhage following bipedal lymphography. Intensive Care Med 1996, 22:614-615.