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Published on: February 10, 2021
Percutaneous Lymphatic Embolization for Chylothorax Secondary to Gorham-Stout Disease
David Yurui Lim1,2, Saebeom Hur3, Hee Eun Moon1
1Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
Insights
Percutaneous lymphatic embolization is effective for Gorham-Stout disease (GSD) related chylothorax. Targeting the thoracic duct and pleural lymphatics achieved 80% success, offering a feasible treatment option.
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.
Objective:
To assess the role and treatment response of percutaneous lymphatic embolization performed for non-traumatic chylothorax in patients with Gorham-Stout disease (GSD) with regard to thoracic duct embolization (TDE) and embolization of pleural or lymphatic collaterals.
Materials And Methods:
This retrospective single-institution study included consecutive patients who underwent percutaneous lymphatic embolization between January 2013 and December 2022. The patients underwent dynamic contrast-enhanced magnetic resonance lymphangiography, fluoroscopic intranodal lymphangiography, or both to evaluate the lymphatic anatomy prior to the intervention. The patients underwent TDE, pleural lymphatic embolization, or both, depending on the imaging findings. The data collected included imaging findings, procedural details, and clinical outcomes (clinical success was defined as removal of the drainage catheter without re-accumulation of effusion or improvement in clinical symptoms).
Results:
Five male patients (aged 5-29 years) with chylothorax (n = 3) or hemorrhagic chylothorax (n = 2) were included. The key imaging findings included giant thoracic duct (n = 3) and dilated parietal pleural lymphatic system (n = 5). Twelve embolization sessions were performed (median, 2 sessions per patient; range 1-4 sessions). The embolized lymphatic structures included the thoracic duct (n = 4), parietal pleural lymphatics (n = 4), and other lymphatic collaterals (n = 3). The embolic agents used were glue and coils (n = 3), and glue only (n = 2). TDE alone achieved clinical success in only 25% of the cases (1 out of 4). With additional embolization of the parietal pleural lymphatics and other collaterals, clinical success was achieved in 80% of the cases (4 out of 5). One patient developed chylous ascites after the TDE.
Conclusion:
Percutaneous lymphatic embolization targeting the thoracic duct and pleural lymphatic collaterals is a feasible treatment option for GSD-related chylothorax.
