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Pediatric lymphangiography, thoracic duct embolization and thoracic duct disruption: a single-institution experience in 11 children with chylothorax

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Interventional radiology treatment of chylothorax is well described in adults, with high technical and clinical success that decreases patient morbidity and mortality. However there is limited experience in children.


To report the technical and clinical success of lymphangiography, thoracic duct embolization and thoracic duct disruption in the pediatric population.

Materials and methods

We studied 11 pediatric patients (7 boys, 4 girls; median weight 6.0 kg) who underwent lymphangiography and thoracic duct embolization from November 2015 to May 2017. All 11 (100%) children presented with chylothorax, with 1 (9%) having concomitant chylous ascites and 1 (9%) having concomitant chylopericardium. Ten (91%) children had traumatic chylothorax and one (9%) had congenital chylothorax. We recorded technical success, clinical success and complications.


Twelve procedures were completed in 11 children. Bilateral intranodal lymphangiography was technically successful in all (100%) patients. Central lymphatics were visualized in eight (67%) procedures. Access to central lymphatics was attempted in eight procedures and successful in five (63%). In three (37%) of the eight procedures, disruption was performed when the central lymphatics could not be accessed. Clinical success was achieved in 7/11 (64%) children. Three minor complications were reported. No major complications were encountered.


Lymphangiography, thoracic duct embolization and thoracic duct disruption are successful interventional strategies in children with chylothorax and should be considered as viable treatment options at any age.

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  1. Tutor JD (2014) Chylothorax in infants and children. Pediatrics 133:722–733

    Article  PubMed  Google Scholar 

  2. Chan EH, Russell JL, Williams WG et al (2005) Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg 80:1864–1870

    Article  PubMed  Google Scholar 

  3. Chan SY, Lau W, Wong WH et al (2006) Chylothorax in children after congenital heart surgery. Ann Thorac Surg 82:1650–1656

    Article  PubMed  Google Scholar 

  4. Nath DS, Savla J, Khemani RG et al (2009) Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg 88:246–252

    Article  PubMed  Google Scholar 

  5. Dori Y, Keller MS, Rychik J et al (2014) Successful treatment of plastic bronchitis by selective lymphatic embolization in a Fontan patient. Pediatrics 134:e590–e595

    Article  PubMed  Google Scholar 

  6. Courtney M, Ayyagari RR (2015) Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation. Pediatr Radiol 45:927–930

    Article  PubMed  Google Scholar 

  7. Chung A, Gill AE, Rahman FN et al (2015) Retrograde thoracic duct embolization in a pediatric patient with total cavopulmonary connection with plastic bronchitis. J Vasc Interv Radiol 26:1743–1746

    Article  PubMed  Google Scholar 

  8. Snow AL, Uller W, Kim HB et al (2014) Percutaneous embolization of a chylous leak from thoracic duct injury in a child. Cardiovasc Intervent Radiol 37:1111–1113

    Article  PubMed  Google Scholar 

  9. Itkin M, Krishnamurthy G, Naim MY et al (2011) Percutaneous thoracic duct embolization as a treatment for intrathoracic chyle leaks in infants. Pediatrics 128:e237–e241

    Article  PubMed  Google Scholar 

  10. Dori Y, Keller MS, Rome JJ et al (2016) Percutaneous lymphatic embolization of abnormal pulmonary lymphatic flow as treatment of plastic bronchitis in patients with congenital heart disease. Circulation 133:1160–1170

    Article  PubMed  Google Scholar 

  11. Itkin M, Kucharczuk JC, Kwak A et al (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139:584–589

    Article  PubMed  Google Scholar 

  12. Nadolski GJ, Itkin M (2012) Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 23:613–616

    Article  PubMed  Google Scholar 

  13. Rajebi MR, Chaudry G, Padua HM et al (2011) Intranodal lymphangiography: feasibility and preliminary experience in children. J Vasc Interv Radiol 22:1300–1305

    Article  PubMed  Google Scholar 

  14. Omary RA, Bettmann MA, Cardella JF et al (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14:S293–S295

    Article  PubMed  Google Scholar 

  15. Maldonado F, Hawkins FJ, Ryu JH et al (2009) Pleural fluid characteristics of chylothorax. Mayo Clin Proc 84:129–133

    Article  PubMed  PubMed Central  Google Scholar 

  16. Maldonado F, Cartin-Ceba R, Hawkins FJ et al (2010) Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci 339:314–318

    Article  PubMed  Google Scholar 

  17. Majdalany BS, Murrey DA, Kapoor BS et al (2017) ACR appropriateness criteria chylothorax treatment planning. J Am Coll Rad 14:S118–S126

    Article  Google Scholar 

  18. Nadolski GJ, Itkin M (2013) Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients. Chest 143:158–163

    Article  PubMed  Google Scholar 

  19. Pamarthi V, Stecker MS, Schenker MP et al (2014) Thoracic duct embolization and disruption for treatment of chylous effusions: experience with 105 patients. J Vasc Interv Radiol 25:1398–1404

    Article  PubMed  Google Scholar 

  20. Yannes M, Shin D, McCluskey K et al (2017) Comparative analysis of intranodal lymphangiography with percutaneous intervention for postsurgical chylous effusions. J Vasc Interv Radiol 28:704–711

    Article  PubMed  Google Scholar 

  21. Guevara CJ, Rialon KL, Ramaswamy RS et al (2017) US-guided, direct puncture retrograde thoracic duct access, lymphangiography, and embolization: feasibility and efficacy. J Vasc Interv Radiol 27:1890–1896

    Article  Google Scholar 

  22. Koike Y, Nishimura J, Hirai C et al (2013) Percutaneous transvenous embolization of the thoracic duct in the treatment of chylothorax in two patients. J Vasc Interv Radiol 24:135–137

    Article  PubMed  Google Scholar 

  23. Gough MH (1964) Lymphangiography in children. Arch Dis Child 39:177–181

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Bill S. Majdalany.

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Majdalany, B.S., Saad, W.A., Chick, J.F.B. et al. Pediatric lymphangiography, thoracic duct embolization and thoracic duct disruption: a single-institution experience in 11 children with chylothorax. Pediatr Radiol 48, 235–240 (2018).

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