Skip to main content
SpringerLink
Log in

Thoracic Duct Dysplasias and Chylous Reflux

  • Chapter
Hemangiomas and Vascular Malformations

  • 2318 Accesses

Abstract

Complex clinical pictures can develop in patients with thoracic duct and lymphatic dysplasias, due to duct anomalies and malformations of the lymphatic, cisterna chili, and chyliferous collectors, with parietal-valvular insufficiency and related chylous reflux syndromes. Adequate diagnosis of the nature and sites of the chylous obstruction and/or leakage is essential to a successful long-term outcome. Various surgical procedures, made after a proper metabolic control by TPN and MCT dietary regimen, may include: (1) identification of the sites of obstruction, leakage, and chylous reflux; (2) drainage of the chylothorax: the thoracic duct can be ligated, repaired, or diverted by means of appropriate microsurgical procedures, with possible additional pleurodesis, through a minimally invasive video-thoracoscopic approach; (3) removal of chylolymphocele, chylous cysts, and/or chylomas with, when possible, wide resection of chylolymphangiodysplasic, and chylolymphangiectasic tissues, if present, can be very effective, together with “spaced-out” anti-gravitational ligatures of dilated and incompetent chylolymphatic collectors; (4) the optional use of CO2 LASER; and (5) the microsurgical derivative multiple lymphatic-venous anastomoses (LVA) or reconstructive lymphatic-venous-lymphatic autologous interpositioned shunts offer a functional repair of the chylolymphatic pathways, if performable.

The choice of the optimal procedure and the ideal timing of the surgical intervention in these complex cases requires the skill of experienced teams with suitable technology and equipment.

An erratum to this chapter can be found at http://dx.doi.org/10.1007/978-88-470-5673-2_54

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hematti H, Mehran RJ (2011) Anatomy of the thoracic duct. Thorac Surg Clin 21:229–238

    Article  PubMed  Google Scholar 

  2. Kato T, Takase K, Ichikawa H et al (2011) Thoracic duct visualization: combined use of multidetector-row computed tomography and magnetic resonance imaging. J Comput Assist Tomogr 35:260–265

    Article  PubMed  Google Scholar 

  3. Gottwald F, Finke C, Zenk J (2005) Thoracic duct cysts: a rare differential diagnosis. Otolaryngol Head Neck Surg 132:330–333

    Article  PubMed  Google Scholar 

  4. Okuda I, Udagawa H, Hirata K et al (2011) Depiction of the thoracic duct by magnetic resonance imaging: comparison between magnetic resonance imaging and the anatomical literature. Jpn J Radiol 29:39–45

    Article  PubMed  Google Scholar 

  5. Preyer S, Kaiserling E, Heinle H, Foldi E, Zenner HP, Foldi M (1995) Benign supraclavicular tumorous lymphangiectasia: a new disease? Lymphology 28:118–125

    CAS  PubMed  Google Scholar 

  6. Hara H, Mihara M, Okuda I, Hirota A, Narushima M, Iida T, Yamamoto T, Todokoro T, Koshima I (2012) Presence of thoracic duct abnormalities in patients with primary lymphoedema of the extremities. J Plast Reconstr Aesthet Surg 65:e305–e310

    Article  PubMed  Google Scholar 

  7. Boccardo F, Bellini C, Eretta C et al (2007) The lymphatics in the pathophysiology of thoracic duct and abdominal surgical pathology: immunological consequences and the unexpected role of microsurgery. Microsurgery 27:339–345

    Article  PubMed  Google Scholar 

  8. Boccardo F, Campisi CC, Molinari L, Dessalvi S, Santi PL, Campisi C (2012) Lymphatic complications in surgery: possibility of prevention and therapeutic options. Updates Surg 64:211–216

    Article  PubMed  Google Scholar 

  9. Boccardo F, Campisi C, Murdaca G et al (2010) Prevention of lymphatic injuries in surgery. Microsurgery 30:401–404

    PubMed  Google Scholar 

  10. Addas R, Thumerel M, Jougon J, Delcambre F, Lelly J-F (2013) Are there early clinical factors to decide early surgical management for secondary chylothorax? A review of 32 cases. Open J Thorac Surg 3:30–36

    Article  Google Scholar 

  11. Noel AA, Gloviczki P, Bender CE, Whitley D, Stanson AD, Deschamps C (2001) Treatment of symptomatic primary chylous disorders. J Vasc Surg 34:785–791

    Article  CAS  PubMed  Google Scholar 

  12. Hara H, Koshima I, Okuda I et al (2012) Assessment of configuration of thoracic duct using magnetic resonance thoracic ductography in idiopathic lymphedema. Ann Plast Surg 68:300–302

    Article  CAS  PubMed  Google Scholar 

  13. Offiah CE, Twigg S (2011) Lymphocoele of the thoracic duct: a cause of left supraclavicular fossa. Br J Radiol 84:27–30

    Article  Google Scholar 

  14. Boccardo F, Campisi CC, Molinari L, Dessalvi S, Santi PL, Campisi C (2012) Diagnosis and treatment of chylous disorders. Lymphology 23:15–19

    Google Scholar 

  15. Campisi C, Bellini C, Campisi C et al (2010) Microsurgery for lymphedema: clinical research and long-term results. Microsurgery 30:256–260

    PubMed  Google Scholar 

  16. Yu D, Ma XX, Wang Q, Zhang Y, Li CF (2013) Morphological changes of the thoracic duct and accessory lymphatic channels in patients with chylothorax: detection with unenhanced magnetic resonance imaging. Eur Radiol 23:702–711

    Article  PubMed  Google Scholar 

  17. Lee RKL, Wang K (2013) Technetium-99 m filtrated sulfur colloid lymphoscintigraphy for assessment of the site of lymphatic leakage in chylothorax post-oesophagectomy. Hong Kong J Radiol 16:e5–e8

    Article  Google Scholar 

  18. Campisi CC, Boccardo F, Piazza C, Campisi C (2013) Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg 21(2):150–156

    Article  PubMed  Google Scholar 

  19. Sharkey AJ, Rao JN (2012) The successful use of octreotide in the treatment of traumatic chylothorax. Tex Heart Inst J 39:428–430

    PubMed Central  PubMed  Google Scholar 

  20. Rosti LD, Battisti F, Butera G et al (2005) Octreotide in the management of postoperative chylothorax. Pediatr Cardiol 26:440–443

    Article  CAS  PubMed  Google Scholar 

  21. Li W, Dan G, Jiang J, Zhao Y, Deng D (2013) A 2-wk conservative treatment regimen preceding thoracic duct ligation is effective and safe for treating post-esophagectomy chylothorax. J Surg Res 185:784–789

    Article  PubMed  Google Scholar 

  22. Lyon S, Mott N, Koukounaras J, Shoobridge J, Hudson PV (2013) Role of interventional radiology in the management of chylothorax: a review of the current management of high output chylothorax. Cardiovasc Intervent Radiol 36(3):599–607

    Article  PubMed  Google Scholar 

  23. Merrigan BA, Winter DC, O’Sullivan GC (1997) Chylothorax. Br J Surg 84:15–20

    Article  CAS  PubMed  Google Scholar 

  24. Brennan PA, Blythe JN, Herd MK et al (2012) The contemporary management of chyle leak following cervical thoracic duct damage. Br J Oral Maxillofac Surg 50:197–201

    Article  CAS  PubMed  Google Scholar 

  25. ChalretduRieu M, Baulieux J, Rode A et al (2011) Management of postoperative chylothorax. J Visc Surg 148:346–352

    Article  Google Scholar 

  26. Stringel G, Teixeira JA (2000) Thoracoscopic ligation of the thoracic duct. JSLS 4:239–242

    PubMed Central  CAS  PubMed  Google Scholar 

  27. Taniguchi Y, Miwa K, Adachi Y et al (2011) Thoracoscopic resection of a thoracic duct cyst that developed during follow-up for a thymic cyst. Gen Thorac Cardiovasc Surg 59:133–136

    Article  PubMed  Google Scholar 

  28. Zoetmulder F, Rutgers E, Baas P (1994) Thoracoscopic ligation of a thoracic duct leakage. Chest 106:1233–1234

    Article  CAS  PubMed  Google Scholar 

  29. Ilczyszyn A, Ridha H, Durrani AJ (2011) Management of chyle leak post neck dissection: a case report and literature review. J Plast Reconstr Aesthet Surg 64:223–230

    Article  Google Scholar 

  30. Lapp GC, Brown DH, Gullane PJ et al (1998) Thoracoscopic management of chylous fistulae. Am J Otolaryngol 19:257–262

    Article  CAS  PubMed  Google Scholar 

  31. Abdel-Galil K, Milton R, McCaul J (2009) High output chyle leak after neck surgery: the role of video-assisted thoracoscopic surgery. Br J Oral Maxillofac Surg 47:478–480

    Article  PubMed  Google Scholar 

  32. Anestis N, Christos FC, Ioannis P, Christos I, Lampros P, Stephanos P (2012) Thoracic duct injury due to left subclavicular vein catheterization: a new conservative approach to a chyle fistula using biological glue. Int J Surg Case Rep 3(7):330–332

    Article  PubMed Central  PubMed  Google Scholar 

  33. Christodoulou M, Ris HB, Pezzetta E (2006) Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax. Eur J Cardiothorac Surg 29:810–814

    Article  PubMed  Google Scholar 

  34. Raguse J, Pfitzmann R, Bier J et al (2007) Lower-extremity lymphedema following neck dissection – an uncommon complication after cervical ligation of the thoracic duct. Oral Oncol 43:835–837

    Article  PubMed  Google Scholar 

  35. Le Pimpec-Barthes F, Pham M, Jouan J et al (2009) Peritoneoatrial shunting for intractable chylous ascites complicating thoracic duct ligation. Ann Thorac Surg 87:1601–1603

    Article  PubMed  Google Scholar 

  36. Laslett D, Tretorola SO, Itkin M (2012) Delayed complications following technically successful thoracic duct embolization. J Vasc Interv Radiol 23:76–79

    Article  PubMed  Google Scholar 

  37. Tasnádi G, Bihari I, Bihari P (2010) Peritoneo-venous shunt implantation as a therapy for chylous ascites. Phlebologie 1:24–27

    Google Scholar 

  38. Campisi C, Boccardo F (2004) Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. World J Surg 28:609–613

    Article  PubMed  Google Scholar 

  39. Campisi CC, Larcher L, Lavagno R, Spinaci S, Adami M, Boccardo F, Santi P, Campisi C (2012) Microsurgical primary prevention of lymphatic injuries following breast cancer treatment. Plast Reconstr Surg 130:749e–750e

    Article  CAS  PubMed  Google Scholar 

  40. Campisi C, Boccardo F, Campisi CC, Ryan M (2013) Reconstructive microsurgery for lymphedema: while the early bird catches the worm, the late riser still benefits. J Am Coll Surg 216:506–507

    Article  PubMed  Google Scholar 

  41. Ryan M, Campisi CC, Boccardo F et al (2013) Surgical treatment for lymphedema: optimal timing and optimal techniques. J Am Coll Surg 216:1221–1223

    Article  PubMed  Google Scholar 

  42. Morotti M, Menada MV, Boccardo F, Ferrero S, Casabona F, Villa G, Campisi C, Papadia A (2013) Lymphedema microsurgical preventive healing approach for primary prevention of lower limb lymphedema after inguinofemoral lymphadenectomy for vulvar cancer. Int J Gynecol Cancer 23(4):769–774

    Article  PubMed  Google Scholar 

  43. Campisi CC, Ryan M, Boccardo F et al (2014) Ly.M.P.H.A. and the prevention of lymphatic injuries: a rationale for early microsurgical intervention. J Reconstr Microsurg 30:71–72

    PubMed  Google Scholar 

  44. Boccardo F, Dessalvi S, Campisi C, Molinari L, Spinaci S, Talamo G, Campisi C (2014) Microsurgery for groin lymphocele and lymphedema after oncologic surgery. Microsurgery 34:10–13

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery (DISC), Section & Research Center of Lymphatic Surgery, Lymphology, and Microsurgery, Operative Unit of General and Lymphatic Surgery, IRCCS University Hospital San Martino – IST National Institute for Cancer Research, Genoa, Italy

    Corradino Campisi MD, PhD, FACS, Melissa Ryan PhD & Francesco Boccardo MD, PhD

  2. Postgraduate School of Alimentary Tract Surgery, Siena, Italy

    Corradino Campisi MD, PhD, FACS

  3. Department of Health Sciences (DISSAL), Operative Unit of Dermatology, IRCCS University Hospital San Martino – IST National Institute for Cancer Research, Genoa, Italy

    Caterina Sara Campisi MD

  4. Department of Surgery (DISC), Operative Unit of Plastic, Reconstructive and Aesthetic Surgery, IRCCS University Hospital San Martino – IST National Institute for Cancer Research, Genoa, Italy

    Corrado Cesare Campisi MD, RAS-ACS

Authors
  1. Corradino Campisi MD, PhD, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa Ryan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caterina Sara Campisi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Boccardo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Corrado Cesare Campisi MD, RAS-ACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Corradino Campisi MD, PhD, FACS .

Editor information

Editors and Affiliations

  1. Department of Vascular Surgery, Center for Vascular Malformations "Stefan Belov", Clinical Institute Humanitas "Mater Domini", Castellanza (Varese), Italy

    Raul Mattassi

  2. Vascular Malformations, Facharztklinik Hamburg, Hamburg, Germany

    Dirk A. Loose

  3. Department of Vascular Surgery, "G. Salvini" Hospital, Garbagnate Milanese (Milan), Italy

    Massimo Vaghi

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Italia

About this chapter

Cite this chapter

Campisi, C., Ryan, M., Campisi, C.S., Boccardo, F., Campisi, C.C. (2015). Thoracic Duct Dysplasias and Chylous Reflux. In: Mattassi, R., Loose, D., Vaghi, M. (eds) Hemangiomas and Vascular Malformations. Springer, Milano. https://doi.org/10.1007/978-88-470-5673-2_52

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5673-2_52

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5672-5

  • Online ISBN: 978-88-470-5673-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation