Postmastectomy/Axillary Node Dissection Chyloma: The Additional Value of SPECT/CT Lymphoscintigraphy

Area of Science:

• Oncology
• Radiology
• Surgical Anatomy

Background:

• Chylous leakage is a rare complication following mastectomy and axillary node dissection.
• Anatomical variations in the thoracic duct's termination can lead to injury during breast surgery.
• Retrograde chyle leak may occur due to damage to the lateral terminating branches of the thoracic duct.

Observation:

• A patient presented with chylous leakage at the wound site after a left simple mastectomy and axillary node dissection.
• Lymphoscintigraphy using Tc-99m albumin nanocolloid was performed to investigate the leakage.
• A hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) study was additionally conducted.

Findings:

• The hybrid SPECT/CT study successfully and accurately identified the precise site of chyle leakage.
• This imaging modality proved crucial in pinpointing the source of the complication.

Implications:

• Accurate localization of chyle leaks is essential for effective surgical management.
• Hybrid SPECT/CT imaging offers a valuable tool for diagnosing and guiding treatment of post-surgical chylous leakage.
• Understanding thoracic duct anatomy is critical for minimizing surgical complications in breast cancer patients.