1Sooraj Suresh Rahila,1Fouad Nawaf Ahmad Hammad, 1Hammad Rashid R M Al Hamar, 1Dr. Ali R.Barah
Imaging findings on Lymphangiogram and CT. Discussing the management of Chylous Leak. Highlights the technique and principles for embolization
Material(s) and Method(s):
Chylous leaks, such as chylothorax and chylopericardium, are uncommon effusions resulting from the leakage of intestinal lymphatic fluid from the thoracic duct (TD). The cause can be either traumatic or nontraumatic. The Treatment is traditionally consisted surgery. This can occur anywhere along the pathway of chyle that begins in the intestinal lymphatic ducts and continue through the cisterna chyli and into the TD. Thoracic duct embolization (TDE) has become a viable treatment alternative due to it high success rate and minimal complications.
PTDE is a minimally invasive image-guided intervention by using sclerosant agents . TDE has better outcomes than conservative management. Percutaneous lymphangiography technique by USG is used to directly access the hilum of an inguinal lymph node with a 24G LP needle is used for injecting an oil-based contrast agent at a rate of 1 to 2 mL per 5 minutes up to 6 mL, which should achieve appropriate opacification of the abdominal and pelvic lymphatics.
When the target duct is confirmed, a 22G chiba needle is used for transabdominal access under fluoroscopy. A stiff 0.018 guidewire is used to access the duct, a 2.4 or 3Fr 65cm microcatheter is used to advanced over the wire into the TD, after which the guidewire may be removed contrast is then injected to define the source of the leak and TD anatomy. The TD is then embolized with a sclerosant agents.
TDE is an important alternative treatment to patients with traumatic and nontraumatic chylous leaks with no associated mortality, minimal morbidity, and a high success rate.