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Pediatric lymphangiography, thoracic duct embolization and thoracic duct disruption: a single-institution experience
Bill S Majdalany1, Wael A Saad2, Jeffrey Forris Beecham Chick2
1Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. bmajdala@med.umich.edu.
Insights
Interventional radiology, including lymphangiography and thoracic duct embolization, shows promise for treating pediatric chylothorax. These minimally invasive techniques offer a viable treatment option for children with this condition.
Area of Science:
- Interventional Radiology
- Pediatric Medicine
- Thoracic Surgery
Background:
- Chylothorax treatment in adults via interventional radiology is established, with high success rates.
- Limited data exists on the efficacy and safety of these procedures in pediatric patients.
Purpose of the Study:
- To evaluate the technical and clinical success of lymphangiography, thoracic duct embolization, and thoracic duct disruption in children.
- To assess the safety and feasibility of these interventional techniques in the pediatric population.
Main Methods:
- Retrospective study of 11 pediatric patients (median weight 6.0 kg) undergoing lymphangiography and thoracic duct embolization.
- Procedures included intranodal lymphangiography, thoracic duct embolization, and thoracic duct disruption when central lymphatic access was not achieved.
Main Results:
- Bilateral intranodal lymphangiography was technically successful in 100% of patients.
- Clinical success was achieved in 64% of children (7/11).
- Three minor complications occurred, with no major complications reported.
Conclusions:
- Lymphangiography, thoracic duct embolization, and thoracic duct disruption are effective interventional strategies for pediatric chylothorax.
- These minimally invasive procedures should be considered for treating chylothorax in children of all ages.
Background:
Interventional radiology treatment of chylothorax is well described in adults, with high technical and clinical success that decreases patient morbidity and mortality. However there is limited experience in children.
Objective:
To report the technical and clinical success of lymphangiography, thoracic duct embolization and thoracic duct disruption in the pediatric population.
Materials And Methods:
We studied 11 pediatric patients (7 boys, 4 girls; median weight 6.0 kg) who underwent lymphangiography and thoracic duct embolization from November 2015 to May 2017. All 11 (100%) children presented with chylothorax, with 1 (9%) having concomitant chylous ascites and 1 (9%) having concomitant chylopericardium. Ten (91%) children had traumatic chylothorax and one (9%) had congenital chylothorax. We recorded technical success, clinical success and complications.
Results:
Twelve procedures were completed in 11 children. Bilateral intranodal lymphangiography was technically successful in all (100%) patients. Central lymphatics were visualized in eight (67%) procedures. Access to central lymphatics was attempted in eight procedures and successful in five (63%). In three (37%) of the eight procedures, disruption was performed when the central lymphatics could not be accessed. Clinical success was achieved in 7/11 (64%) children. Three minor complications were reported. No major complications were encountered.
Conclusion:
Lymphangiography, thoracic duct embolization and thoracic duct disruption are successful interventional strategies in children with chylothorax and should be considered as viable treatment options at any age.
