Ultrasound-guided intranodal lymphangiography followed by thoracic duct embolization for treatment of postoperative bilateral chylothorax

Abstract Background Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce ultrasound-guided intranodal lymphangiography and embolisation techniques for postoperative lymphatic leakage in patients with cancer. Methods From January 2018 through June 2020, seven cancer patients (three males, four females, aged 59–75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volumes ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolisation were recorded. This study retrospectively analysed the technical success rate, operative time, length of hospital stay, clinical efficacy, and complications. Results The operation was technically successful in all patients. Angiography revealed leakage, and embolisation was performed in all seven patients (7/7, 100%). The operative time of angiography and embolisation was 41 to 68 min, with an average time of 53.29 ± 10.27 min. The mean length of stay was 3.51 ± 1.13 days. Lymph node embolisation was clinically successful in five patients (5/7, 71.43%), who had a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment 2 weeks later due to poor results after embolisation. All patients were followed for 2 weeks. No serious complications or only minor complications were found in all the patients. Conclusions Ultrasound-guided intranodal lymphangiography and embolisation were well tolerated by the patients, who experienced a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.

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An overview of ultrasound-guided transnodal lymphangiography with percutaneous thoracic duct embolization

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.12.553 ◽

2014 ◽

Vol 25 (3) ◽

pp. S205-S206

Author(s):

S.T. Kee Bansal ◽

J. McWilliams ◽

E.W. Lee

Keyword(s):

Thoracic Duct ◽

Ultrasound Guided

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Fatal Bilateral Chylothorax in Mice Lacking the Integrin α9β1

Molecular and Cellular Biology ◽

10.1128/mcb.20.14.5208-5215.2000 ◽

2000 ◽

Vol 20 (14) ◽

pp. 5208-5215 ◽

Cited By ~ 199

Author(s):

X. Z. Huang ◽

J. F. Wu ◽

R. Ferrando ◽

J. H. Lee ◽

Y. L. Wang ◽

...

Keyword(s):

Respiratory Failure ◽

Thoracic Duct ◽

Lymphocytic Infiltration ◽

Cell Matrix ◽

Bilateral Chylothorax ◽

Matrix Interactions ◽

Congenital Chylothorax ◽

Cell Matrix Interactions ◽

Cell Adhesion Molecule 1

ABSTRACT Members of the integrin family of adhesion receptors mediate both cell-cell and cell-matrix interactions and have been shown to play vital roles in embryonic development, wound healing, metastasis, and other biological processes. The integrin α9β1 is a receptor for the extracellular matrix proteins osteopontin and tenacsin C and the cell surface immunoglobulin vascular cell adhesion molecule-1. This receptor is widely expressed in smooth muscle, hepatocytes, and some epithelia. To examine the in vivo function of α9β1, we have generated mice lacking expression of the α9 subunit. Mice homozygous for a null mutation in the α9 subunit gene appear normal at birth but develop respiratory failure and die between 6 and 12 days of age. The respiratory failure is caused by an accumulation of large volumes of pleural fluid which is rich in triglyceride, cholesterol, and lymphocytes. α9 −/− mice also develop edema and lymphocytic infiltration in the chest wall that appears to originate around lymphatics. α9 protein is transiently expressed in the developing thoracic duct at embryonic day 14, but expression is rapidly lost during later stages of development. Our results suggest that the α9 integrin is required for the normal development of the lymphatic system, including the thoracic duct, and that α9 deficiency could be one cause of congenital chylothorax.

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ULTRASOUND-GUIDED MESENTERIC LYMPH NODE IOHEXOL INJECTION FOR THORACIC DUCT COMPUTED TOMOGRAPHIC LYMPHOGRAPHY IN CATS

Veterinary Radiology & Ultrasound ◽

10.1111/j.1740-8261.2010.01794.x ◽

2011 ◽

Vol 52 (3) ◽

pp. 302-305 ◽

Cited By ~ 14

Author(s):

MIEUN KIM ◽

HYEYEON LEE ◽

NAMSOON LEE ◽

MIHYEON CHOI ◽

JUNYOUNG KIM ◽

...

Keyword(s):

Lymph Node ◽

Mesenteric Lymph Node ◽

Thoracic Duct ◽

Ultrasound Guided ◽

Computed Tomographic ◽

Mesenteric Lymph

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Application of Ultrasound-guided Intranodal Lymphangiography and Embolization in Cancer Patients with Postoperative Lymphatic Leakage

10.21203/rs.3.rs-73630/v2 ◽

2021 ◽

Author(s):

Xingwei Sun ◽

Feng Zhou ◽

Xuming Bai ◽

Qiang Yuan ◽

Mingqing Zhang ◽

...

Keyword(s):

Cancer Patients ◽

Operative Time ◽

Length Of Hospital Stay ◽

Chylous Ascites ◽

Pelvic Surgery ◽

Ultrasound Guided ◽

Technical Success Rate ◽

Life Threatening ◽

Low Incidence ◽

Intranodal Lymphangiography

Abstract Background: Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce ultrasound-guided intranodal lymphangiography and embolisation techniques for postoperative lymphatic leakage in patients with cancer.Methods: From January 2018 through June 2020, seven cancer patients (three males, four females, aged 59-75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volumes ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolisation were recorded. This study retrospectively analysed the technical success rate, operative time, length of hospital stay, clinical efficacy, and complications.Results: The operation was technically successful in all patients. Angiography revealed leakage and embolisation was performed in all seven patients (7/7, 100%). The operative time of angiography and embolisation was 41 to 68 minutes, with an average time of 53.29 ± 10.27 minutes. The mean length of stay was 3.51±1.13 days. Lymph node embolisation was clinically successful in five patients (5/7, 71.43%), who had a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment two weeks later due to poor results after embolisation. All patients were followed for two weeks. No serious complications or only minor complications were found in all the patients.Conclusions: Ultrasound-guided intranodal lymphangiography and embolisation were well tolerated by the patients, who experienced a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.

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Case Report: Management of idiopathic chylothorax

F1000Research ◽

10.12688/f1000research.6694.1 ◽

2015 ◽

Vol 4 ◽

pp. 1049 ◽

Cited By ~ 1

Author(s):

Maher Abouda ◽

Yangui Ferdaous ◽

Miriam Triki ◽

Mehdi Charfi ◽

Mohamed Ridha Charfi

Keyword(s):

Case Report ◽

Pleural Fluid ◽

Medical Therapy ◽

Thoracic Duct ◽

Medium Chain Triglyceride ◽

Pleural Space ◽

Low Fat Diet ◽

Thoracic Duct Ligation ◽

Bilateral Chylothorax ◽

Duct Ligation

Chylothorax is characterized by the presence of chyle in the pleural space and results from lesion or obstruction of the thoracic duct. We present two cases of non-traumatic, idiopathic chylothorax in two females that were treated differently. The first is a 42 year old female who presented with a symptomatic right chylothorax. Treatment by a low-fat diet supplemented with medium chain triglyceride and evacuation of the pleural fluid was sufficient. The second patient is a 25 year old female admitted for a bilateral chylothorax. Despite optimal medical therapy, chylothorax continued to persist. Finally thoracic duct ligation was performed, which resulted in resolution of the effusion. These two cases illustrate that the management of idiopathic chylothorax can be surgical or nonsurgical.

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Application of Ultrasound-Guided Intranodal Lymphangiography and Embolization in Cancer Patients With Postoperative Lymphatic Leakage

10.21203/rs.3.rs-73630/v1 ◽

2020 ◽

Author(s):

Xingwei Sun ◽

Feng Zhou ◽

Xuming Bai ◽

Qiang Yuan ◽

Mingqing Zhang ◽

...

Keyword(s):

Cancer Patients ◽

Operation Time ◽

Chylous Ascites ◽

Pelvic Surgery ◽

Ultrasound Guided ◽

Technical Success Rate ◽

Patients With Cancer ◽

Life Threatening ◽

Low Incidence ◽

Intranodal Lymphangiography

Abstract Background: Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce the technique of ultrasound-guided intranodal lymphangiography and embolization in the postoperative lymphatic leakage in patients with cancer.Methods: During January 2018 and June 2020, seven cancer patients (three males, four females, aged 59-75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volume ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolization were recorded. This study retrospectively analysed the technical success rate, operation time, hospital stay, clinical efficacy, and complications.Results：The operation was technically successful in all patients. Angiography revealed leakage and embolization was performed in all the seven patients (7/7, 100%). The operative time of angiography and embolization was 41 to 68 minutes, with an average time of 53.29 ± 10.27 minutes. The mean length of stay was 3.51±1.13 days. Lymph node embolization was finally clinically successful in five patients (5/7, 71.43%), with a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment 2 weeks later due to poor results after embolization. All patients were followed-up for 2 weeks. No serious complications or only minor complications were found in all the patients.Conclusions：Ultrasound-guided intranodal lymphangiography and embolization are easy to tolerance, with a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.

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