Thoracic Duct Embolization for Chylous Leaks

Overview

Journal Semin Intervent Radiol

Specialty Radiology

Date 2012 Mar 2

PMID 22379277

Citations 63

Authors

Eric Chen

Maxim Itkin

Affiliations

Soon will be listed here.

Abstract

Chylous leaks, such as chylothorax and chylopericardium, are uncommon effusions resulting from the leakage of intestinal lymphatic fluid from the thoracic duct (TD) and its tributaries, or intestinal lymphatic ducts. The cause can be either traumatic (thoracic surgery) or nontraumatic (idiopathic, malignancy). Treatment has traditionally consisted of dietary modification (nonfat diet) and/or surgery (TD ligation, pleurodesis). Thoracic duct embolization (TDE) has become a viable treatment alternative due to it high success rate and minimal complications. In this article, the authors describe the etiologies of chylothorax, patient population, outcomes, and long-term follow-up of TDE patients. Relevant lymphatic anatomy and physiology are reviewed, with special attention paid to the formation of the duct by tributaries at the cisterna chyli (CC). The technique of TDE is outlined, including bilateral pedal lymphangiography, TD cannulation, and embolic agents used for the procedure.

Citing Articles

Lymphangiogram of a case of presumed lymphatic filariasis with left-sided cisterna chyli.

Mak S, Lee K, Cho H Radiol Case Rep. 2025; 20(3):1512-1516.

PMID: 39807123 PMC: 11727317. DOI: 10.1016/j.radcr.2024.11.083.

Postoperative chylous ascites successfully managed by selective lymphatic embolization: Case report and literature review.

Cuong N, Van Anh N, Linh L, Hoa T Radiol Case Rep. 2024; 20(2):1189-1193.

PMID: 39697260 PMC: 11652851. DOI: 10.1016/j.radcr.2024.11.007.

Lymphatic Malformations: Review of Diagnosis and Management for the Interventional Radiologist.

Lee S, Luhar A, Miller J Semin Intervent Radiol. 2024; 41(4):389-403.

PMID: 39524235 PMC: 11543113. DOI: 10.1055/s-0044-1791281.

Traumatic chylothorax: a case report, treatment options and an update of the literature.

de Goede B, de Jong L, van Rossem C, Schep N AME Case Rep. 2024; 8:105.

PMID: 39380856 PMC: 11459413. DOI: 10.21037/acr-24-34.

Novel temperature responsive polymer based sealant for embolization.

Dabiri A, Narain R, Peng Y, Wang W, Itkins M, Kassab G Sci Technol Adv Mater. 2024; 25(1):2409059.

PMID: 39372058 PMC: 11451279. DOI: 10.1080/14686996.2024.2409059.

References

Romero S . Nontraumatic chylothorax. Curr Opin Pulm Med. 2000; 6(4):287-91. DOI: 10.1097/00063198-200007000-00006. View

Loukas M, Wartmann C, Louis Jr R, Tubbs R, Salter E, Gupta A . Cisterna chyli: a detailed anatomic investigation. Clin Anat. 2007; 20(6):683-8. DOI: 10.1002/ca.20485. View

Christodoulou M, Ris H, Pezzetta E . Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax. Eur J Cardiothorac Surg. 2006; 29(5):810-4. DOI: 10.1016/j.ejcts.2006.01.064. View

Schild H, Hirner A . Percutaneous translymphatic thoracic duct embolization for treatment of chylothorax. Rofo. 2001; 173(7):580-2. DOI: 10.1055/s-2001-15838. View

Pomerantz M, HERDT J, ROCKOFF S, KETCHAM A . EVALUATION OF THE FUNCTIONAL ANATOMY OF THE THORACIC DUCT BY LYMPHANGIOGRAPHY. J Thorac Cardiovasc Surg. 1963; 46:568-75. View

Marts B, Naunheim K, Fiore A, Pennington D . Conservative versus surgical management of chylothorax. Am J Surg. 1992; 164(5):532-4; discussion 534-5. DOI: 10.1016/s0002-9610(05)81195-x. View

Itkin M, Kucharczuk J, Kwak A, Trerotola S, Kaiser L . Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg. 2010; 139(3):584-89. DOI: 10.1016/j.jtcvs.2009.11.025. View

Maldonado F, Cartin-Ceba R, Hawkins F, Ryu J . Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci. 2010; 339(4):314-8. DOI: 10.1097/MAJ.0b013e3181cdcd6c. View

Dunn R . Primary chylopericardium: a review of the literature and an illustrated case. Am Heart J. 1975; 89(3):369-77. DOI: 10.1016/0002-8703(75)90088-5. View

10.

KAUSEL H, Reeve T, Stein A, Alley R, STRANAHAN A . Anatomic and pathologic studies of the thoracic duct. J Thorac Surg. 1957; 34(5):631-41. View

11.

Cope C . Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol. 1998; 9(5):727-34. DOI: 10.1016/s1051-0443(98)70382-3. View

12.

Thompson K, Kernstine K, Grannis Jr F, Mojica P, Falabella A . Treatment of chylothorax by robotic thoracic duct ligation. Ann Thorac Surg. 2007; 85(1):334-6. DOI: 10.1016/j.athoracsur.2007.04.109. View

13.

Cope C, Kaiser L . Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol. 2002; 13(11):1139-48. DOI: 10.1016/s1051-0443(07)61956-3. View

14.

Rosenberger A, Adler O, ABRAMS H . The thoracic duct: structural, functional, and radiologic aspects. CRC Crit Rev Radiol Sci. 1972; 3(4):523-41. View

15.

Matsumoto T, Yamagami T, Kato T, Hirota T, Yoshimatsu R, Masunami T . The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol. 2008; 82(976):286-90. DOI: 10.1259/bjr/64849421. View

16.

Choo J, Foley P, Lyon S . Percutaneous management of high-output chylothorax: case reviews. Cardiovasc Intervent Radiol. 2009; 32(4):828-32. DOI: 10.1007/s00270-009-9545-3. View

17.

Ludwig J, Linhart P, BAGGENSTOSS A . Hepatic lymph drainage in cirrhosis and congestive heart failure. A postmortem lymphangiographic study. Arch Pathol. 1968; 86(5):551-62. View

18.

Cope C . Percutaneous transabdominal embolization of thoracic duct lacerations in animals. J Vasc Interv Radiol. 1996; 7(5):725-31. DOI: 10.1016/s1051-0443(96)70840-0. View

19.

Erden A, Fitoz S, Yagmurlu B, Erden I . Abdominal confluence of lymph trunks: detectability and morphology on heavily T2-weighted images. AJR Am J Roentgenol. 2004; 184(1):35-40. DOI: 10.2214/ajr.184.1.01840035. View

20.

Cope C, Salem R, Kaiser L . Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial. J Vasc Interv Radiol. 1999; 10(9):1248-54. DOI: 10.1016/s1051-0443(99)70227-7. View