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.
Similar content being viewed by others
References
Aalami OO, Allen DB, Organ CH (2000) Chylous ascites: a collective review. Surgery 128(5):761–778
Merrigan BA, Winter DC, O’Sullivan GC (1997) Chylothorax. Br J Surg 84(1):15–20
Guermazi A, Brice P, Hennequin C, Sarfati E (2003) Lymphography: an old technique retains its usefulness. Radiographics 23(6):1541–1558
Syed LH, Georgiades CS, Hart VL (2007) Lymphangiography: a case study. Semin Intervent Radiol 24(1):106–110
Yamagami T, Masunami T, Kato T et al (2005) Spontaneous healing of chyle leakage after lymphangiography. Br J Radiol 78(933):854–857
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
Choo JC, Foley PT, Lyon SM (2009) Percutaneous management of high-output chylothorax: case reviews. Cardiovasc Intervent Radiol 32(4):828–832
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
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
Noel AA, Gloviczki P, Bender CE et al (2001) Treatment of symptomatic primary chylous disorders. J Vasc Surg 34(5):785–791
Barbetakis N, Asteriou C, Konstantinou D et al (2010) Spontaneous chylous cardiac tamponade: a case report. J Cardiothorac Surg 5:11
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
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
Hillerdal G (1997) Chylothorax and pseudochylothorax. Eur Respir J 10(5):1157–1162
Browse NL, Allen DR, Wilson NM (1997) Management of chylothorax. Br J Surg 84(12):1711–1716
Doerr CH, Allen MS, Nichols FC, Ryu JH (2005) Etiology of chylothorax in 203 patients. Mayo Clin Proc 80:867–870
Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC (1996) Postoperative chylothorax. J Thorac Cardiovasc Surg 112(5):1361–1365
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
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
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
Cardenas A, Chopra S (2002) Chylous ascites. Am J Gastroenterol 97(8):1896–1900
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
Gomes CS, Handa GI, Silveira FP et al (2009) Surgical treatment of chylous ascites. J Vascr Brasileiro 8:192–197
Diamond E, Schapira HE (1985) Chyluria―a review of the literature. Urology 26(5):427–431
Sharma S, Hemal A (2009) Chyluria―an overview. Int J Nephrol Urol 1(1):14–26
Yu NC, Raman SS, Patel M, Barbaric Z (2004) Fistulas of the genitourinary tract: a radiologic review. Radiographics 24(5):1331–1352
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
Gulati S, Gupta N, Singh NP et al (2007) Chyluria with proteinuria or filarial nephropathy? An enigma. Parasitol Int 56(3):251–254
Kinmonth JB (1952) Lymphangiography in man: a method of outlining lymphatic trunks at operation. Clin Sci (Lond) 11(1):13–20
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
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
Bron KM, Baum S, Abrams HL (1963) Oil embolism in lymphangiography: incidence, manifestations, and mechanism. Radiology 80:194–202
Takahashi M, Abrams HL (1967) Arborizing pulmonary embolization following lymphangiography. Report of three cases and an experimental study. Radiology 89(4):633–638
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
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
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
Mortazavi SH, Burrows BD (1971) Allergic reaction to patient blue dye in lymphangiography. Clin Radiol 22(3):389–390
Rubin BE (1978) Extravasation of ethiodol into deep tissues of the foot: a complication of lymphangiography. AJR Am J Roentgenol 131(2):342–343
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
Dupont H, Timsit JF, Souweine B et al (1996) Intra-alveolar hemorrhage following bipedal lymphography. Intensive Care Med 22(6):614–615
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
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-010-0066-x