EURORAD ESR

Case 12838

Thoracic duct embolization with coils and glue to treat post-esophagectomy lymphatic leakage

Author(s)
Maciel C1, Boatta E2, Garnon J2, Jahn Ch2

1Hospital São João, Radiology Department; Alameda Prof. Hernâni Monteiro 4200-319 Porto, Portugal.Email:tina_maciel@yahoo.com
2Nouvel Hôpital Civil, Service d'Imagerie A, Imagerie Interventionnelle;1 Place de L' Hôpital, 67000 Strasbourg, France.
 
Patient
female, 59 year(s)
 
 
  • Figure 1
    Bilateral chylothorax post-esophagectomy

    Axial contrast enhanced CT image performed three days after esophagectomy shows bilateral pleural effusion. A chest tube was already in place at the right side (arrow). Bilateral thoracocentesis confirmed the...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
  • Figure 2
    Intranodal lymphangiography
     

    Initial spot fluoroscopic image of right inguinal region shows acess to two right inguinal lymph nodes with 25-gauge needles (arrows), with sucessful opacification of efferent lymphatic vessels with Lipiodol.

     
    Area of Interest: Lymphatic; Imaging Technique: Lymphography; Procedure: Diagnostic procedure; Special Focus: Trauma;

    Follow up spot fluoroscopic image of lower abdomen demonstrates upward move/flow of Lipiodol to lumbar lymphatics (arrows).

     
    Area of Interest: Lymphatic; Imaging Technique: Lymphography; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 3
    Thoracic duct embolization
     

    After transabdominal puncture of TD with a 22-gauge spinal under fluoroscopic guidance, catheterization of TD with microguide and microcatheter followed. Notice microguide (arrow).

     
    Area of Interest: Lymphatic; Imaging Technique: Fluoroscopy; Procedure: Embolisation; Special Focus: Trauma;

    Fluoroscopic spot image of thoracic region, obtained after TD catheterization and contrast injection, reveals the course of TD (arrows) and evidence of lymphatic leak with pooling of contrast at 7th dorsal spine level...

     
    Area of Interest: Lymphatic; Imaging Technique: Fluoroscopy; Procedure: Embolisation; Special Focus: Trauma;

    Spot fluoroscopic image obtained during glue embolization (Glubran) and after liberation of one detachable coil -3x8 mm, Concerto, Medtronic (short arrow). Notice the radiopac tip of the 2.0 Fr microcatheter (arrow)....

     
    Area of Interest: Lymphatic; Imaging Technique: Fluoroscopy; Procedure: Embolisation; Special Focus: Trauma;
     
     
  • Figure 4
    Final control with cone beam CT after thoracic duct embolization

    Cone beam coronal CT image without contrast clearly depicts the leakage point (arrow) at the left upper thoracic region with adjacent huge pooling of contrast (asterisk). Notice the opacified retroperitoneal...

     
    Area of Interest: Lymphatic; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Trauma;
     
     
  • Figure 5
    Thoracic duct anatomy

    Schematic diagram illustrates the typical course of the thoracic duct, seen in approximately 65% of population. 1-cisterna chyli; 2-thoracic duct, 3-subclavian jugular venous system, 4-1st rib arch.

     
    Area of Interest: Anatomy; Imaging Technique: Lymphography; Procedure: Embolisation; Special Focus: Trauma;
     
     
  • Figure 6
    Thoracic duct anatomic variants

    Schematic diagram illustrates TD anatomic variants. May be challenging to advance a guidewire in the plexiform variants due to the small size of the multiple trunks; this may cause technical...

     
    Area of Interest: Anatomy; Imaging Technique: Lymphography; Procedure: Embolisation; Special Focus: Trauma;
     
     
  • Figure 7
    Follow-up chest radiograph

    Follow-up chest radiograph, two months after TDE, demonstrates resolution of the left-sided pleural effusion and a small residual right-sided pleural effusion, in keeping with sucessful TDE. Notice metallic...

     
    Area of Interest: Lymphatic; Imaging Technique: Digital radiography; Procedure: Diagnostic procedure; Special Focus: Foreign bodies;
     
     
Axial contrast enhanced CT image performed three days after esophagectomy shows bilateral pleural effusion. A chest tube was already in place at the right side (arrow). Bilateral thoracocentesis confirmed the diagnosis of bilateral chylothorax.
 
Initial spot fluoroscopic image of right inguinal region shows acess to two right inguinal lymph nodes with 25-gauge needles (arrows), with sucessful opacification of efferent lymphatic vessels with Lipiodol.
 
Follow up spot fluoroscopic image of lower abdomen demonstrates upward move/flow of Lipiodol to lumbar lymphatics (arrows).
 
After transabdominal puncture of TD with a 22-gauge spinal under fluoroscopic guidance, catheterization of TD with microguide and microcatheter followed. Notice microguide (arrow).
 
Fluoroscopic spot image of thoracic region, obtained after TD catheterization and contrast injection, reveals the course of TD (arrows) and evidence of lymphatic leak with pooling of contrast at 7th dorsal spine level (short arrowhead).
 
Spot fluoroscopic image obtained during glue embolization (Glubran) and after liberation of one detachable coil -3x8 mm, Concerto, Medtronic (short arrow). Notice the radiopac tip of the 2.0 Fr microcatheter (arrow). Oesophageal prosthesis is seen.
 
Cone beam coronal CT image without contrast clearly depicts the leakage point (arrow) at the left upper thoracic region with adjacent huge pooling of contrast (asterisk). Notice the opacified retroperitoneal lymphatics (short arrows).
 
Schematic diagram illustrates the typical course of the thoracic duct, seen in approximately 65% of population. 1-cisterna chyli; 2-thoracic duct, 3-subclavian jugular venous system, 4-1st rib arch.
 
Schematic diagram illustrates TD anatomic variants. May be challenging to advance a guidewire in the plexiform variants due to the small size of the multiple trunks; this may cause technical failure of the procedure.
 
Follow-up chest radiograph, two months after TDE, demonstrates resolution of the left-sided pleural effusion and a small residual right-sided pleural effusion, in keeping with sucessful TDE. Notice metallic embolization coil (circle) and oesophageal prosthesis (arrow).
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version