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Endovascular Catheter-Based Management of Chylous Effusions

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Lymphedema

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Abstract

Chylous effusions are the accumulation of chyle in the body cavities, which present as milky exudates high in lymphocytes and triglyceride content. The characteristics of the chylous effusion can vary depending on nutritional status, enteral intake, and comorbidities. Thoracic duct embolization (TDE) is a percutaneous minimally invasive alternative to open surgical ligation of the thoracic duct (TD) for treating chylothorax of any etiology. The originally described procedure involves bilateral pedal lymphangiography to opacify the lymphatic system followed by transabdominal catheterization of the TD and embolization of TD with glue and coils. A recently described US-guided intranodal lymphangiogram, which is less technically challenging than pedal lymphangiogram, facilitated wide dissemination of TDE worldwide. TDE was reported to be successful in over 70% of patients with chylothorax without appreciable morbidity or mortality.

Development of MR lymphangiogram techniques, such as T2 imaging and dynamic contrast-enhanced MR lymphangiogram (DCRML), allowed dynamic imaging of the central lymphatic system, providing anatomical and pathological information about the lymphatic system and the guidance for the interventional procedures.

Using diagnostic and treatment algorithm based on MR lymphangiogram, it became possible to successfully treat nontraumatic chylothorax using percutaneous embolization techniques. DCRML also allowed discovery of abnormal pulmonary lymphatic perfusion syndrome (PLPS), which is the cause of conditions such as neonatal chylothorax and plastic bronchitis. Application of the percutaneous embolization techniques to treat these conditions offered new minimally invasive and effective therapeutic solutions for these patients.

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Authors and Affiliations

  1. Children’s Hospital of Philadelphia, Penn Medicine, Philadelphia, PA, USA

    Max Itkin MD, FSIR

  2. Hospital of University of Pennsylvania, 3400 Spruce street, Philadelphia, PA, 19004, USA

    Max Itkin MD, FSIR

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  1. Max Itkin MD, FSIR
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Correspondence to Max Itkin MD, FSIR .

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Editors and Affiliations

  1. Center for the Lymphedema and Vascular Malformations, Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, DC, USA

    Byung-Boong Lee

  2. Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California, USA

    Stanley G. Rockson

  3. La Jolla, California, USA

    John Bergan

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Itkin, M. (2018). Endovascular Catheter-Based Management of Chylous Effusions. In: Lee, BB., Rockson, S., Bergan, J. (eds) Lymphedema. Springer, Cham. https://doi.org/10.1007/978-3-319-52423-8_65

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  • DOI: https://doi.org/10.1007/978-3-319-52423-8_65

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