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Thoracic duct disruption without lymphangiographic thoracic duct visualization for refractory chylothorax: A case
Takaki Hirano1, Masayoshi Yamamoto1, Hiroshi Kondo1
1Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
Radiology Case Reports
|November 29, 2023
Summary
Thoracic duct disruption (TDD) can treat refractory chylothorax when imaging fails. This study shows TDD via retrocrural puncture improved chylothorax when lymphangiography was unsuccessful.
Area of Science:
- Interventional Radiology
- Thoracic Surgery
- Gastroenterology
Background:
- Refractory chylothorax is a challenging condition often managed with surgical ligation.
- Percutaneous treatments like thoracic duct embolization (TDE) and thoracic duct disruption (TDD) offer less invasive alternatives.
- TDD typically requires opacification of the thoracic duct via lymphangiography for successful catheterization.
Observation:
- A case where standard intranodal lymphangiography failed to visualize the thoracic duct, precluding conventional TDE.
- The patient had refractory chylothorax, necessitating an alternative percutaneous approach.
Findings:
- Thoracic duct disruption was successfully performed by directly puncturing the suspected retrocrural location of the thoracic duct.
- This alternative TDD technique led to clinical improvement of the patient's chylothorax.
Implications:
- This approach expands the utility of TDD for refractory chylothorax, even when the thoracic duct is not visualized via lymphangiography.
- Direct retrocrural puncture represents a viable strategy for TDD when standard catheterization methods fail.
- Further research may validate this technique for similar challenging cases in interventional radiology.
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