Percutaneous Lymphatic Embolization for Chylothorax Secondary to Gorham-Stout Disease

Area of Science:

• Interventional Radiology
• Vascular Medicine
• Pediatric Cardiology

Background:

• Gorham-Stout disease (GSD) can cause debilitating chylothorax.
• Traditional treatments for GSD-related chylothorax have limitations.
• Percutaneous lymphatic embolization offers a minimally invasive approach.

Purpose of the Study:

• To evaluate the efficacy of percutaneous lymphatic embolization for non-traumatic chylothorax in GSD patients.
• To assess treatment response to thoracic duct embolization (TDE) and collateral lymphatic embolization.
• To determine the role of lymphatic embolization in managing GSD-related chylothorax.

Main Methods:

• Retrospective single-institution study (2013-2022) of patients with GSD-related chylothorax.
• Pre-intervention lymphatic imaging using MRI lymphangiography and/or intranodal lymphangiography.
• Percutaneous embolization targeting the thoracic duct, pleural lymphatics, or both, using glue and coils or glue alone.

Main Results:

• Five male patients (5-29 years) with chylothorax or hemorrhagic chylothorax were included.
• Key findings included giant thoracic duct (3/5) and dilated pleural lymphatics (5/5).
• Combined TDE and collateral embolization achieved 80% clinical success, compared to 25% for TDE alone.

Conclusions:

• Percutaneous lymphatic embolization is a feasible treatment for GSD-related chylothorax.
• Targeting both the thoracic duct and pleural lymphatic collaterals improves treatment success.
• This minimally invasive technique offers a viable therapeutic option for complex chylothorax.