Lymphangiogram by bilateral inguinal intranodal approach
Interventional radiologyCase Type
Daniel Hynes, MB BCh BAO; Bertrand Janne d’Othée, MD, MPH, MBA.Patient
55 years, male
55 year-old-male with an idiopathic left-sided chylothorax (500-600 ml/day for >1 week), which became non-chylous after starting total parenteral nutrition. Thereafter, left pleural tube output increased to 850 ml/day.
Ultrasound-guided bilateral inguinal intranodal approach enabled slow continuous Lipiodol infusion and antegrade abdominopelvic lymphangiogram. Bilateral inguinal and iliac lymph nodes and their connecting lymphatic ducts were opacified by slow antegrade, caudocranial flow of Lipiodol. The Lipiodol eventually reached the normal-appearing cisterna chyli after two hours.
Right anterolateral transabdominal puncture of the thoracic duct (TD) near the cisterna chyli was achieved. Transcatheter lymphangiograms of the thoracic duct using iodinated contrast showed multifocal deposits of Lipiodol in the left hemithorax, thus confirming the known chylothorax. TD disruption was performed.
Retrograde transcatheter embolisation of the thoracic duct was executed using a ‘sandwich’ technique with cranial and caudal packing of detachable and pushable micro coils and ethylene vinyl alcohol (Onyx 34) interposed between both coil packs.
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