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[Intranodal lymphangiography in pediatric chylothorax, a diagnostic and therapeutic tool]

J Jiménez Gómez1, M Gómez Cervantes1, V Núñez Cerezo1

  • 1Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.

Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica
|February 5, 2019
PubMed

Insights

Intranodal lymphangiography (IL) with ethiodized oil shows promise in managing pediatric chylothorax, potentially sealing lymphatic leaks in postsurgical cases. This technique offers a diagnostic and therapeutic option when other treatments fail or are not feasible.

Area of Science:

  • Pediatric Interventional Radiology
  • Thoracic Surgery
  • Lymphatic Imaging

Background:

  • Secondary chylothorax in children carries high morbidity.
  • Thoracic duct embolization (TDE) after intranodal lymphangiography (IL) is established in adults but lacks pediatric data.
  • This study evaluates the experience with IL and TDE in pediatric refractory chylothorax.

Observation:

  • Four pediatric patients with refractory chylothorax were treated.
  • Three cases were secondary to cardiothoracic surgery; one was due to venous thrombosis.
  • Medical management failed to reduce thoracic output prior to IL.

Findings:

  • Successful thoracic duct catheterization was achieved in one patient, but embolization was not possible.
  • Chylothorax resolved in all three postsurgical patients, irrespective of lymphatic visualization.
  • Ethiodized oil may contribute to sealing lymphatic leaks in postsurgical chylothorax.

Implications:

  • Intranodal lymphangiography (IL) serves as a valuable diagnostic and therapeutic tool in pediatric chylothorax.
  • Ethiodized oil embolization could be a viable treatment for postsurgical lymphatic leaks.
  • IL presents an alternative for critically ill children or those unsuitable for TDE.
Abstract

Keywords:
ChildrenChylothoraxEthiodized oilIntranodal lymphangiography

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