Percutaneous embolization of a chylous leak from thoracic duct injury in a child

Area of Science:

• Interventional Radiology
• Pediatric Surgery
• Thoracic Surgery

Background:

• Postoperative chylous leak, including chylothorax and chyloperitoneum, can occur after thoracic or neck surgeries due to thoracic duct injury.
• Management of persistent chylous leaks can be challenging, particularly in pediatric patients post-transplantation.
• Inflammatory myofibroblastic tumors (IMT) of the retroperitoneum may necessitate complex surgical interventions like multivisceral transplantation.

Observation:

• A pediatric patient developed persistent chylothorax and chyloperitoneum after multivisceral transplantation for an unresectable retroperitoneal IMT.
• Conventional treatments were insufficient to resolve the persistent chylous effusion.
• Intranodal lymphangiography was employed to precisely identify the origin of the chylous leak.

Findings:

• Intranodal lymphangiography successfully localized the chylous leak to the lower thoracic duct segment.
• Percutaneous embolization of the identified thoracic duct leak was performed.
• The chylous leak resolved completely within days following the embolization procedure.

Implications:

• Percutaneous embolization is an effective minimally invasive treatment for thoracic duct injuries causing chylous leaks.
• Intranodal lymphangiography is a valuable diagnostic tool for pinpointing the site of chylous leaks.
• This approach offers a successful therapeutic option for complex pediatric cases, such as post-transplantation chylous effusions.