Selective Lymphatic Duct Embolization in Patients With Chylothorax and Thoracic Duct Side-Branch Injury

Chylothorax, the accumulation of chyle in the pleural space, is a potentially fatal condition that necessitates intervention. Options range from conservative treatment, such as dietary modifications and pharmacological therapy, to percutaneous and surgical interventions. This case describes a 56-year-old male status post-lung wedge resection who developed a high-output chylothorax. Initial management with octreotide and a low-fat diet was unsuccessful. A percutaneous lymphangiogram identified extravasation of contrast from a thoracic duct side-branch. Instead of traditional thoracic duct embolization (TDE), selective lymphatic duct embolization (SLDE) was performed to preserve the main thoracic duct. The patient had rapid symptom resolution and successful chest tube removal. The patient was discharged within two days, without recurrence of symptoms. While TDE is a common percutaneous approach, it carries the risk of complete thoracic duct occlusion. This can lead to lymphatic backflow and leaks. When a single branch of the thoracic duct is injured, SLDE offers a novel alternative to target that side-branch while maintaining thoracic duct integrity. Comparative studies suggest SLDE provides similar efficacy to TDE while reducing severe complications. More research is needed to establish the long-term risks versus benefits of SLDE. SLDE is a promising, minimally invasive intervention for high-output chylothorax. It offers a safer alternative to TDE when a side-branch injury exists. This case highlights its potential for improving patient outcomes with fewer complications.