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Lymphangiography in the Diagnosis and Localization of Various Chyle Leaks

  • Clinical Investigation
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Abstract

Purpose

Chyle leaks are rare entities infrequently encountered by most physicians. However, large centers providing advanced surgical care are inevitably confronted with chyle leaks as a complication of surgery, an extension of disease, or as a primary disorder. Regardless of the etiology, proper diagnosis and localization are paramount in the management of any chyle leak.

Materials and Methods

Here we present 16 patients with 17 chyle leaks (5 chyluria, 8 chylothorax, and 4 chylous ascites) who underwent bipedal lymphangiography (LAG) and postprocedure computed tomography (CT) imaging.

Results

In each case, the source of the chyle leak was identified and properly localized to guide further treatment. Of the 16 patients who underwent LAG and postprocedure CT imaging, the initial LAG alone provided the diagnosis and localized the chyle leak in 4 patients (25%); the postprocedure CT imaging provided the diagnosis and localized the chyle leak in 6 patients (37.5%); and the two modalities were equal in the diagnosing and localizing the chyle leak in the remaining 6 patients (37.5%)

Conclusion

These cases highlight the unparalleled abilities of LAG and the added benefit of post-LAG CT imaging in the diagnosis and fine anatomic localization of chyle leaks. In addition, these cases demonstrate the retained utility of LAG in these investigations despite the development of alternative tests involving CT, magnetic resonance imaging, and nuclear medicine imaging.

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References

  1. Aalami OO, Allen DB, Organ CH (2000) Chylous ascites: a collective review. Surgery 128(5):761–778

    Article  PubMed  CAS  Google Scholar 

  2. Merrigan BA, Winter DC, O’Sullivan GC (1997) Chylothorax. Br J Surg 84(1):15–20

    Article  PubMed  CAS  Google Scholar 

  3. Guermazi A, Brice P, Hennequin C, Sarfati E (2003) Lymphography: an old technique retains its usefulness. Radiographics 23(6):1541–1558

    Article  PubMed  Google Scholar 

  4. Syed LH, Georgiades CS, Hart VL (2007) Lymphangiography: a case study. Semin Intervent Radiol 24(1):106–110

    Article  PubMed  Google Scholar 

  5. Yamagami T, Masunami T, Kato T et al (2005) Spontaneous healing of chyle leakage after lymphangiography. Br J Radiol 78(933):854–857

    Article  PubMed  CAS  Google Scholar 

  6. Matsumoto T, Yamagami T, Kato T et al (2009) The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol 82(976):286–290

    Article  PubMed  CAS  Google Scholar 

  7. Choo JC, Foley PT, Lyon SM (2009) Percutaneous management of high-output chylothorax: case reviews. Cardiovasc Intervent Radiol 32(4):828–832

    Article  PubMed  Google Scholar 

  8. Kos S, Haueisen H, Lachmund U, Roeren T (2007) Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Intervent Radiol 30(5):968–973

    Article  PubMed  Google Scholar 

  9. Deso S, Kabutey N-K, Vilvendhan R, Kim D, Guermazi A (2010) Lymphangiography in the diagnosis, localization, and treatment of a lymphaticopelvic fistula causing chyluria: a case report. Vasc Endovasc Surg 44(8):710–713

    Article  Google Scholar 

  10. Noel AA, Gloviczki P, Bender CE et al (2001) Treatment of symptomatic primary chylous disorders. J Vasc Surg 34(5):785–791

    Article  PubMed  CAS  Google Scholar 

  11. Barbetakis N, Asteriou C, Konstantinou D et al (2010) Spontaneous chylous cardiac tamponade: a case report. J Cardiothorac Surg 5:11

    Article  PubMed  Google Scholar 

  12. Tahara M, Katsumi A, Akazawa T, Otsuka Y, Kitahara S (2010) Post-traumatic chylous knee effusion. Knee. Available at: www.sciencedirect.com. Accessed 15 Aug 2010

  13. Liu M-E, Branstetter BF, Whetstone J, Escott EJ (2006) Normal CT appearance of the distal thoracic duct. AJR Am J Roentgenol 187(6):1615–1620

    Article  PubMed  Google Scholar 

  14. Hillerdal G (1997) Chylothorax and pseudochylothorax. Eur Respir J 10(5):1157–1162

    Article  PubMed  CAS  Google Scholar 

  15. Browse NL, Allen DR, Wilson NM (1997) Management of chylothorax. Br J Surg 84(12):1711–1716

    Article  PubMed  CAS  Google Scholar 

  16. Doerr CH, Allen MS, Nichols FC, Ryu JH (2005) Etiology of chylothorax in 203 patients. Mayo Clin Proc 80:867–870

    Article  PubMed  Google Scholar 

  17. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC (1996) Postoperative chylothorax. J Thorac Cardiovasc Surg 112(5):1361–1365

    Article  PubMed  CAS  Google Scholar 

  18. Hashim SA, Roholt HB, Babayan VK, Vanitallie TB (1964) Treatment of chyluria and chylothorax with medium-chain triglyceride. N Engl J Med 270:756–761

    Article  PubMed  CAS  Google Scholar 

  19. Cope C (1998) Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol 9(5):727–734

    Article  PubMed  CAS  Google Scholar 

  20. Hoffer EK, Bloch RD, Mulligan MS, Borsa JJ, Fontaine AB (2001) Treatment of chylothorax: percutaneous catheterization and embolization of the thoracic duct. AJR Am J Roentgenol 176(4):1040–1042

    PubMed  CAS  Google Scholar 

  21. Cardenas A, Chopra S (2002) Chylous ascites. Am J Gastroenterol 97(8):1896–1900

    PubMed  Google Scholar 

  22. Ablan CJ, Littooy FN, Freeark RJ (1990) Postoperative chylous ascites: diagnosis and treatment. A series report and literature review. Arch Surg 125(2):270–273

    Article  PubMed  CAS  Google Scholar 

  23. Gomes CS, Handa GI, Silveira FP et al (2009) Surgical treatment of chylous ascites. J Vascr Brasileiro 8:192–197

    Article  Google Scholar 

  24. Diamond E, Schapira HE (1985) Chyluria―a review of the literature. Urology 26(5):427–431

    Article  PubMed  CAS  Google Scholar 

  25. Sharma S, Hemal A (2009) Chyluria―an overview. Int J Nephrol Urol 1(1):14–26

    Google Scholar 

  26. Yu NC, Raman SS, Patel M, Barbaric Z (2004) Fistulas of the genitourinary tract: a radiologic review. Radiographics 24(5):1331–1352

    Article  PubMed  Google Scholar 

  27. Koga S, Nagata Y, Arakaki Y, Matsuoka M, Ohyama C (2000) Unilateral pedal lymphography in patients with filarial chyluria. BJU Int 85(3):222–223

    Article  PubMed  CAS  Google Scholar 

  28. Gulati S, Gupta N, Singh NP et al (2007) Chyluria with proteinuria or filarial nephropathy? An enigma. Parasitol Int 56(3):251–254

    Article  PubMed  Google Scholar 

  29. Kinmonth JB (1952) Lymphangiography in man: a method of outlining lymphatic trunks at operation. Clin Sci (Lond) 11(1):13–20

    CAS  Google Scholar 

  30. Lohrmann C, Foeldi E, Speck O, Langer M (2006) High-resolution MR lymphangiography in patients with primary and secondary lymphedema. AJR Am J Roentgenol 187(2):556–561

    Article  PubMed  Google Scholar 

  31. Arrive L, Azizi L, Lewin M et al (2007) MR lymphography of abdominal and retroperitoneal lymphatic vessels. AJR Am J Roentgenol 189(5):1051–1058

    Article  PubMed  CAS  Google Scholar 

  32. Bron KM, Baum S, Abrams HL (1963) Oil embolism in lymphangiography: incidence, manifestations, and mechanism. Radiology 80:194–202

    PubMed  CAS  Google Scholar 

  33. Takahashi M, Abrams HL (1967) Arborizing pulmonary embolization following lymphangiography. Report of three cases and an experimental study. Radiology 89(4):633–638

    PubMed  CAS  Google Scholar 

  34. Hecht H, Berdon W, Baker D (1968) Hepatic oil embolization following lymphangiography in a child with neuroblastoma. Am J Roentgenol Radium Ther Nucl Med 104(4):860–864

    PubMed  CAS  Google Scholar 

  35. Andersen OF, Fogelberg MG, Rosencrantz NM, Weinfeld A, Westin JE (1977) Postlymphographic cerebral lipid embolization in the vena cava superior syndrome. Cancer 39(1):79–84

    Article  PubMed  CAS  Google Scholar 

  36. Kusumoto S, Imamura A, Watanabe K (1991) Case report: the incidental lipid embolization to the brain and kidney after lymphography in a patient with malignant lymphoma: CT findings. Clin Radiol 44(4):279–280

    Article  PubMed  CAS  Google Scholar 

  37. Mortazavi SH, Burrows BD (1971) Allergic reaction to patient blue dye in lymphangiography. Clin Radiol 22(3):389–390

    Article  PubMed  CAS  Google Scholar 

  38. Rubin BE (1978) Extravasation of ethiodol into deep tissues of the foot: a complication of lymphangiography. AJR Am J Roentgenol 131(2):342–343

    PubMed  CAS  Google Scholar 

  39. Winterer JT, Blum U, Boos S, Konstantinides S, Langer M (1999) Cerebral and renal embolization after lymphography in a patient with non-Hodgkin lymphoma: case report. Radiology 210(2):381–383

    PubMed  CAS  Google Scholar 

  40. Dupont H, Timsit JF, Souweine B et al (1996) Intra-alveolar hemorrhage following bipedal lymphography. Intensive Care Med 22(6):614–615

    Article  PubMed  CAS  Google Scholar 

  41. Fein DA, Hanlon AL, Corn BW, Curran WJ, Coia LR (1996) The influence of lymphangiography on the development of hypothyroidism in patients irradiated for Hodgkin’s disease. Int J Radiat Oncol Biol Physiol 36(1):13–18

    Article  CAS  Google Scholar 

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Acknowledgments

A. Guermazi acknowledges the valuable and outstanding teaching of Marie Moutamalle. Without her patience, thousands of patients would not benefit from the diagnostic performance of lymphography.

Conflict of interest

A. Guermazi discloses the following potential conflicts of interest: (1) consultancies with MerckSerono, Facet Solutions, Genzyme, Novartis, and Stryker; (2) honoraria from Novartis; (3) stock ownership in Synarc, Inc.; and (4) grants from General Electric Healthcare. Other relations include president of Boston Imaging Core Lab, LLC.

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Correspondence to Ali Guermazi.

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Deso, S., Ludwig, B., Kabutey, NK. et al. Lymphangiography in the Diagnosis and Localization of Various Chyle Leaks. Cardiovasc Intervent Radiol 35, 117–126 (2012). https://doi.org/10.1007/s00270-010-0066-x

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  • DOI: https://doi.org/10.1007/s00270-010-0066-x

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