Advertisement

Percutaneous Balloon Plasty for Thoracic Duct Occlusion in a Patient with Chylothorax and Chylous Ascites

  • Shuji KariyaEmail author
  • Miyuki Nakatani
  • Yasuyuki Ono
  • Takuji Maruyama
  • Yutaka Ueno
  • Atsushi Komemushi
  • Noboru Tanigawa
Case Report
  • 31 Downloads

Abstract

A patient developed abdominal distension, dyspnea, and nausea due to chylothorax and chylous ascites 1 month after bruising her back. Lymphangiography was unable to identify the site of lymph leakage, and lymphatic duct embolization was impractical. However, lymphangiography showed occlusion of the thoracic duct. Thus, balloon plasty was performed to restore the patency of the thoracic duct, and the chylothorax and chylous ascites improved. Although embolization of the thoracic or lymphatic ducts has been reported as a treatment for lymphorrhea, it is impractical if the lymphatic duct responsible for leakage cannot be identified. In such a case, balloon plasty of the occluded thoracic duct to lower the pressure in the peripheral lymphatic ducts was successfully performed.

Keywords

Chylothorax Chylous ascites Thoracic duct plasty Lymphangiography Balloon 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This case report was approved by our institutional review board, and the requirement to obtain informed consent for inclusion in this study was waived. Informed consent for percutaneous balloon thoracic duct plasty was obtained from the patient before the procedure.

References

  1. 1.
    Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg. 2010;139(3):584–9 discussion 9–90, Epub 2010/01/01.CrossRefGoogle Scholar
  2. 2.
    Nadolski GJ, Itkin M. Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients. Chest. 2013;143(1):158–63 Epub 2012/07/17.CrossRefGoogle Scholar
  3. 3.
    Baek Y, Won JH, Chang SJ, Ryu HS, Song SY, Yim B, et al. Lymphatic embolization for the treatment of pelvic lymphoceles: preliminary experience in five patients. J Vasc Interv Radiol. 2016;27(8):1170–6.CrossRefGoogle Scholar
  4. 4.
    Hur S, Shin JH, Lee IJ, Min SK, Min SI, Ahn S, et al. Early experience in the management of postoperative lymphatic leakage using lipiodol lymphangiography and adjunctive glue embolization. J Vasc Interv Radiol. 2016;27(8):1177–86 e1 Epub 2016/07/01.CrossRefGoogle Scholar
  5. 5.
    Nadolski GJ, Chauhan NR, Itkin M. Lymphangiography and lymphatic embolization for the treatment of refractory chylous ascites. Cardiovasc Intervent Radiol. 2018;41(3):415–23 Epub 2017/12/15.CrossRefGoogle Scholar
  6. 6.
    Laslett D, Trerotola SO, Itkin M. Delayed complications following technically successful thoracic duct embolization. J Vasc Interv Radiol. 2012;23(1):76–9 Epub 2011/11/26.CrossRefGoogle Scholar
  7. 7.
    Dori Y, Keller MS, Rome JJ, Gillespie MJ, Glatz AC, Dodds K, et al. Percutaneous lymphatic embolization of abnormal pulmonary lymphatic flow as treatment of plastic bronchitis in patients with congenital heart disease. Circulation. 2016;133(12):1160–70 Epub 2016/02/13.CrossRefGoogle Scholar
  8. 8.
    Chick JFB, Reddy SN, Murrey DA, Castle JC, Gemmete JJ, Saad WE, et al. Single-session endolymphatic thoracic duct stent-graft placement for recurrent idiopathic chylothorax. J Vasc Interv Radiol. 2017;28(7):1063–7 Epub 2017/06/25.CrossRefGoogle Scholar
  9. 9.
    Pillay TG, Singh B. A review of traumatic chylothorax. Injury. 2016;47(3):545–50 Epub 2016/01/19.CrossRefGoogle Scholar
  10. 10.
    Apostolakis E, Akinosoglou K, Koletsis E, Dougenis D. Traumatic chylothorax following blunt thoracic trauma: two conservatively treated cases. J Cardiac Surg. 2009;24(2):220–2 Epub 2009/03/10.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Shuji Kariya
    • 1
    Email author
  • Miyuki Nakatani
    • 1
  • Yasuyuki Ono
    • 1
  • Takuji Maruyama
    • 1
  • Yutaka Ueno
    • 1
  • Atsushi Komemushi
    • 1
  • Noboru Tanigawa
    • 1
  1. 1.Department of RadiologyKansai Medical UniversityHirakata, OsakaJapan

Personalised recommendations