Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 19;5(1):54.
doi: 10.1186/s42155-022-00333-y.

Management of chyluria using percutaneous thoracic duct stenting

Nguyen Ngoc Cuong  1 , Le Tuan Linh  2 , Thieu Thi Tra My  2 , Tran Quoc Hoa  3 , Hoang Long  3 , Le Hoan  4 , Masanori Inoue  5
Affiliations

Management of chyluria using percutaneous thoracic duct stenting

Nguyen Ngoc Cuong et al. CVIR Endovasc. .

Abstract

Background: Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. CASE PRESENTATION : Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion.

Conclusion: This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.

Keywords: Balloon; Chyluria; Lymphatic; Obstruction; Stenosis; Stent; Thoracic duct.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
DCMRL showed dilated lymphatic vessels in the right renal pelvis (A) and the chylo calyceal fistula (B)
Fig. 2
Fig. 2
First intervention. A Lymphangiography revealed dilated the upper part of TD and remained the contrast in the TD (arrow). B injection of contrast into TD showed occlusion of the TD and dilatation at the junction (arrow). C The 0.014”-guidewire passed through the occlusion into superior vena cava then the femoral vein by a snare. A 6 French-guiding catheter was placed at the junction TD subclavian vein (arrow). D Right retroperitoneal lymphatic system communicates with renal collecting system and the contrast material presented in the kidney calyces (arrow), the interstitial lymphatic embolization was then performed
Fig. 3
Fig. 3
Second intervention. A TD lymphangiography showed re-occlusion of the junction TD vein and collateral circulation of lymphatic vessels in the left neck (arrows). B The stent was inflated in the LVJ by the balloon (arrow). C Injection of contrast after deploying the stent showed the flow into subclavian vein. D superior venogram showed that the contrast material in the left subclavian vein did not reflux to the TD
Fig. 4
Fig. 4
Follow up images. A CT scans 6 months post-stenting revealed the stent was in the right position. B DCMRL after one year showed the patency of thoracic duct
See this image and copyright information in PMC

References

    1. An R, Xia S, Sun Y, Chang K, Li Y, Shen W. New application of direct lymphangiography in the diagnosis and treatment of chylothorax after lung cancer surgery: a case series. Ann Palliat Med. 2021;10(4):4768–4776. doi: 10.21037/apm-21-263. - DOI - PubMed
    1. Chick JFB, Hage AN, Patel N, Gemmete JJ, Meadows JM, Srinivasa RN. Chylothorax secondary to venous outflow obstruction treated with transcervical retrograde thoracic duct cannulation with embolization and venous reconstruction. J Vascular Surg Cases Innovations Techniques. 2018;4(3):193–196. doi: 10.1016/j.jvscit.2018.03.010. - DOI - PMC - PubMed
    1. Ghelfi J, Brusset B, Thony F, Decaens T. Successful management of refractory ascites in non-TIPSable patients using percutaneous thoracic duct stenting. J Hepatol. 2022;76(1):216–218. doi: 10.1016/j.jhep.2021.06.033. - DOI - PubMed
    1. Gurevich A, Nadolski GJ, Itkin M. Novel Lymphatic Imaging and Percutaneous Treatment of Chyluria. Cardiovasc Intervent Radiol. 2018;41(12):1968–1971. doi: 10.1007/s00270-018-2035-8. - DOI - PubMed
    1. Hur S, Gurevich A, Nadolski G, Itkin M. Lymphatic Interventional Treatment for Chyluria via Retrograde Thoracic Duct Access. J Vasc Interv Radiol. 2021;32(6):896–900. doi: 10.1016/j.jvir.2021.03.410. - DOI - PubMed

LinkOut - more resources