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Case Reports
. 2020 Jun 29;15(8):1398-1402.
doi: 10.1016/j.radcr.2020.06.014. eCollection 2020 Aug.

Chylothorax treated with targeted sclerotherapy by direct puncture of the lymphatic leakage site

Masamichi Takahashi  1 , Masanori Inoue  2 , Tomoki Wada  1 , Go Kawai  1 , Munetaka Machida  1 , Yujiro Matsuoka  1
Affiliations
Case Reports

Chylothorax treated with targeted sclerotherapy by direct puncture of the lymphatic leakage site

Masamichi Takahashi et al. Radiol Case Rep. .

Abstract

We report a novel application of targeted sclerotherapy to eradicate high-output chylothorax. The patient underwent thoracic duct embolization; however, cannulation of the thoracic duct failed, and thoracic duct disruption was performed. Leakage continued; therefore, the leakage site in the mediastinum was punctured directly under fluoroscopic guidance and a drainage catheter was inserted, followed by sclerotherapy using OK-432. Finally, leakage stopped and chylothorax improved. This technique may be useful for refractory chylothorax in patients where thoracic duct embolization fails.

Keywords: Chylothorax; Direct puncture; OK-432; Sclerotherapy.

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Figures

Fig 1
Fig. 1
First lymphangiography revealing the cisterna chyli (a) and a concentration of Lipiodol (b) on the left side of the thoracic vertebra. The cisterna chyli is punctured with a 21-gauge Chiba needle (c); however, it is not possible to advance the guide wire into the thoracic duct.
Fig 2
Fig. 2
On the second lymphangiography, the lymphatic leakage site is confirmed at the same location as the previous examination (a). The cisterna chyli is not visible and may have been be occluded by the previous procedure. The patient is placed in the prone position, and the lymphatic leakage site is percutaneously punctured with a 19-gauge coaxial needle from the left margin of the eighth thoracic vertebra (b). Following this, a drainage catheter is inserted.
Fig 3
Fig. 3
Injection of iodine contrast media through the drainage catheter reveals a partially encapsulated fluid collection (a), which is connected to the thoracic cavity (b).
Fig 4
Fig. 4
Computed tomography after second lymphangiography showing a drainage catheter in the lymphatic leakage site.
See this image and copyright information in PMC

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