A lateral thoracotomy approach for thoracic duct cannulation and lymphatic fluid collection in a feline model

The objective of the current study was to evaluate the feasibility of lymph collection from the bovine udder and to investigate if the lymphatic fluid might be of diagnostic value in cows infected with Mycobacterium avium subsp. paratuberculosis (MAP), the etiologic agent of paratuberculosis. Lymph fluid collection was attempted from 58 cows, and the reactions of the cows as well as the level of difficulty of the procedure were recorded in 56 animals. Lymph samples (51 in total) were tested for the presence of MAP by nested polymerase chain reaction. Collection of the lymphatic fluid caused no or mild signs of discomfort in 94.6% of the cows; in 51.8% of cows, lymphatic fluid was attained on the first attempt, while sample collection was unsuccessful in 12.1%. Mycobacterium avium subsp. paratuberculosis was detected in 43.1% of all lymph samples. The bacterium was present in 66.7% of cows with clinical Johne’s disease, in 42.8% of asymptomatic cows with a positive or suspicious enzyme-linked immunosorbent assay (ELISA) result in blood, and in 38.7% of cows with a negative ELISA result in blood. The present study shows that the procedure was well tolerated by most cows and can easily be performed on farm. The current report of the isolation of MAP from lymph fluid suggests that the present approach could be used for the early detection of Johne’s disease in cattle.

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Case report: hepatobronchial lymphatic communications in single ventricle patients as a pathophysiological mechanism of plastic bronchitis: diagnosis and treatment

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa415 ◽

2020 ◽

Author(s):

Deborah Rabinowitz ◽

Wolfgang Radtke ◽

Majeed Bhat ◽

Maxim Itkin

Keyword(s):

Case Report ◽

Successful Treatment ◽

Thoracic Duct ◽

Single Ventricle ◽

Pathophysiological Mechanism ◽

Plastic Bronchitis ◽

Case Summary ◽

Contrast Enhanced ◽

Duct Occlusion ◽

Lymphatic Fluid

Abstract Background Plastic bronchitis is a rare but devastating complication in single ventricle patients after Fontan completion. Recent advances in dynamic contrast-enhanced magnetic resonance lymphangiogram demonstrate the typical pathophysiological mechanism of the thoracic duct leaking lymphatic fluid towards the bronchi resulting in intraluminal casts. This has been termed abnormal pulmonary lymphatic perfusion and has been successfully treated in 94% of patients with thoracic duct occlusion. However, in some cases, this aberrant flow is not identified and therefore no intervention is available. This case report identifies a newly discovered origin of abnormal lymphatic flow from the liver to the bronchi and the treatment of these patients. Case summary We report two cases of plastic bronchitis in single ventricle patients with no identified abnormal lymphatic pulmonary perfusion from the thoracic duct. Both patients underwent liver lymphangiogram and demonstrated aberrant flow from the hepatic lymphatic ducts to the bronchi. These were successfully occluded, and plastic bronchitis symptoms resolved in both cases. Discussion The recent discovery of the abnormal pulmonary lymphatic perfusion from the thoracic duct to the bronchi has allowed successful treatment of 94% of single ventricle patients with plastic bronchitis. The discovery of hepatobronchial lymphatic perfusion reveals an occult aetiology of plastic bronchitis and a second target for embolization and successful treatment.

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Thoracic duct lymphatic fluid harbors phenotypically naive T cells for use in adoptive T-cell therapy

Cytotherapy ◽

10.1016/j.jcyt.2020.05.004 ◽

2020 ◽

Vol 22 (10) ◽

pp. 529-535

Author(s):

Jessica B. Foster ◽

Yoav Dori ◽

Stephan A. Grupp ◽

David M. Barrett

Keyword(s):

T Cells ◽

T Cell ◽

Cell Therapy ◽

Thoracic Duct ◽

Adoptive T Cell Therapy ◽

T Cell Therapy ◽

Naive T Cells ◽

Naïve T Cells ◽

Lymphatic Fluid

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PS02.168: THORACIC DUCT EMBOLIZATION IN HIGH-OUTPUT CHYLOTHORAX AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.168 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 169-170

Author(s):

Taku Michiura ◽

Shuji Kariya ◽

Hirokazu Miki ◽

Hiromi Mukaide ◽

Kentaro Inoue ◽

...

Keyword(s):

Esophageal Cancer ◽

Thoracic Duct ◽

Conflicts Of Interest ◽

Clinical Success ◽

Clinical Results ◽

Success Rates ◽

Iodinated Contrast ◽

Leakage Site ◽

Lymphatic Fluid ◽

High Output

Abstract Background Chylothorax after thoracic surgery is initially managed conservatively, but when persistent high-output chylothorax (> 1000 mL/day) is managed conservatively, the mortality rate exceeds 50%. The objective of this study was to examine the clinical results of thoracic duct embolization (TDE) in cases of chylothorax after esophagectomy for esophageal cancer. Methods The data of 9 patients (7 men, 2 women) whounderwent TDE for persistent high-output chylothorax after esophagectomy for esophageal cancer were gathered retrospectively. Lymphangiography was used to identify the supply route of lymphatic fluid from the lumbar lymphatics to the leakage site and lipiodol extravasation and its site. Transcatheter thoracic ductography was used to identify communication between the thoracic duct and the leakage site and extravasation of the iodinated contrast agent. TDE was performed by percutaneous transabdominal approach to cut off the supply route. The technical success and clinical success (drainage volume ≥ 10mL/kg/day within 7 days after TDE) of TDE were evaluated. Results The technical and clinical success rates of TDE were 89.9%, with no serious complications observed. In 44% of patients, the thoracic duct had ruptured. In the other 56%, the ruptured was in a collateral route bypassing the thoracic duct; the leaking lymphatic fluid was supplied without passing through the thoracic duct in 50% of these patients, but clinical success was achieved even in such patients. Conclusion TDE was found to be a safe method of treatment, with no serious complications. Disclosure All authors have declared no conflicts of interest.

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Bilateral chylothorax complicating a case of chronic lymphocytic leukemia: a case report

Clinics and Practice ◽

10.4081/cp.2017.951 ◽

2017 ◽

Vol 7 (2) ◽

Author(s):

Munish Sharma ◽

Divakar Sharma

Keyword(s):

Case Report ◽

Chronic Lymphocytic Leukemia ◽

Thoracic Duct ◽

Pleural Space ◽

Lymphocytic Leukemia ◽

Treatment Modalities ◽

Bilateral Chylothorax ◽

Lymphatic Fluid

Chylothorax occurs when lymphatic fluid leaks from the thoracic duct and accumulates in the pleural space. Bilateral chylothorax caused by chronic lymphocytic leukemia (CLL) has been rarely reported in the literature. Sludging of lymph might be the underlying cause. We present a case of bilateral chylothorax in a patient with CLL.We also briefly discuss etiology, possible pathogenesis in our case along with diagnostic options and treatment modalities.

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Chylothorax

10.1093/med/9780199568741.003.0020 ◽

2018 ◽

Author(s):

Anjali Crawshaw

Keyword(s):

Thoracic Duct ◽

Pleural Space ◽

Lymphatic Fluid

Chylothorax is an accumulation of lymphatic fluid in the pleural space due to obstruction or injury of the thoracic duct.

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Percutaneous Translymphocele Embolization of Retroperitoneal Lymphatic Leak

Vascular and Endovascular Surgery ◽

10.1177/15385744211062317 ◽

2021 ◽

pp. 153857442110623

Author(s):

Chris Bent

Keyword(s):

Treatment Options ◽

Fluid Collection ◽

Dietary Modification ◽

Retroperitoneal Abscess ◽

Ultrasound Guided ◽

Iodized Oil ◽

Cyanoacrylate Glue ◽

Percutaneous Access ◽

Glue Embolization ◽

Lymphatic Fluid

Iodized oil-based lymphangiography (LAG) is a well-established diagnostic exam during the workup of postoperative lymphatic leaks. Computed tomography (CT) has been shown to be a useful complement to optimize treatment planning and can easily be performed after conventional LAG. The treatment options for lymphatic leaks include conservative dietary modification, sclerotherapy, embolization, and surgery. We present a case of a 48-year-old man who developed a symptomatic left retroperitoneal lymphatic fluid collection after left nephrectomy, complicated by postoperative retroperitoneal abscess. Retroperitoneal duct leak was confirmed via ultrasound-guided intranodal LAG and post-LAG CT. This leak was successfully managed with N-butyl cyanoacrylate glue embolization of the leaking lymphatics via fluoroscopic-guided catheterization of the leak via percutaneous access through the lymphatic fluid collection.

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