Investig Magn Reson Imaging.  2018 Sep;22(3):182-186. 10.13104/imri.2018.22.3.182.

Postoperative Chylothorax: the Use of Dynamic Magnetic Resonance Lymphangiography and Thoracic Duct Embolization

• Lee CW
• Koo HJ
• Shin JH
• Kim MY
• Yang DH

• KMID: 2421551
• DOI: http://doi.org/10.13104/imri.2018.22.3.182

Abstract

Dynamic enhanced magnetic resonance lymphangiography can be used to provide anatomic and dynamic information for various lymphatic diseases, including thoracic duct injury, and can also help to guide the thoracic duct embolization procedure. We present a case of postoperative chylothorax demonstrated by dynamic enhanced MR lymphangiography. In this case, the chyle leakage site and location of cisterna chyli were clearly visualized by dynamic enhanced MR lymphangiography, thus allowing for management with thoracic duct embolization.

Keyword

Magnetic resonance lymphangiography; Thoracic duct injury; Chylothorax; Thoracic duct embolization

MeSH Terms

Chyle
Chylothorax*
Lymphatic Diseases
Lymphography*
Thoracic Duct*

Figure

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  Fig. 1. Ultrasound-guided inguinal lymph node (arrowheads) selection.

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  Fig. 2. MR lymphangiography for visualizing the cisterna chyli and leakage site. (a) A T2W image showing postoperative multiloculated fluid collection in the left pleural space and chest wall. (b) An enhanced 3D THRIVE image and (c, d) volume-rendered image with the enhanced 3D THRIVE sequence (20 mm thickness) showing the leakage site (arrows) and that the thoracic duct drains into left subclavian vein (arrowheads). (e) Cisterna chyli (arrowhead) was noted on the left side of the T12 level.

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  Fig. 3. Conventional lymphangiography with thoracic duct embolization. (a) The cisterna chyli (arrowhead) was selected using a 2.0 Fr Progreat catheter, and Lipiodol uptake was visualized along the thoracic duct course. (b) Thoracic duct embolization was performed at the leakage site (arrow) using histoacryl glue. (c) Immediate chest radiography revealed the embolized leakage site (arrow) and thoracic duct.

Reference

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