Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.20230101
Jornal Vascular Brasileiro
Case Report

The essential role of thoracic duct embolization in management of traumatic iatrogenic chylothorax

O papel fundamental da embolização do ducto torácico no manejo de quilotórax traumático iatrogênico

Bruno Pagnin Schmid; Guilherme Moratti Gilberto; Marcela Juliano Silva Cunha; Leonardo Guedes Moreira Valle; Gustavo Foronda; Santiago Raul Arrieta; Felipe Nasser; Rodrigo Gobbo Garcia

Downloads: 2
Views: 701

Abstract

This study aims to describe a case series of patients who underwent thoracic duct embolization (TDE) to treat traumatic iatrogenic chylothorax (TIC). Three patients were included: Case #1, a 49-year-old woman with follicular lymphoma developed a TIC following video-assisted thoracoscopic surgery to resect a solid right paravertebral mass and was treated with TDE using microcoils and N-butyl cyanoacrylate (NBCA) glue. Case #2, a 68-year-old man with cardiac amyloidosis developed a TIC following heart transplantation and was treated with TDE using microcoils and ethylene vinyl alcohol copolymer. Case#3: A 6-year-old patient with congenital heart disease developed a TIC following a Fontan procedure and was treated with TDE using NBCA glue. All lesions were identified during lymphangiography and TDE was successfully performed in all cases. TDE is a safe and valuable technique that provides minimally invasive treatment for TCI.

Keywords

thoracic duct, lymphangiography, chylothorax, lymphatic diseases, interventional radiology, embolization, therapeutic

Resumo

Este estudo objetiva descrever uma série de casos de pacientes submetidos a embolização do ducto torácico (EDT) para tratamento de quilotórax iatrogênico (QI). Três pacientes foram incluídos. Caso 1: um homem de 49 anos com linfoma folicular apresentou QI após ressecção de uma massa paravertebral por toracoscopia vídeo-assistida e foi submetido a EDT com micromolas e n-butil-cianoacrilato (NBCA). Caso 2: um homem de 68 anos com amiloidose cardíaca apresentou QI após ser submetido a transplante cardíaco e foi submetido a EDT com micromolas e copolímero de etileno e álcool vinílico. Caso 3: um paciente de 6 anos com malformação cardíaca congênita apresentou QI após cirurgia de Fontan e foi submetido a EDT com NBCA. Todas as lesões foram identificadas durante a linfangiografia, e a EDT foi realizada com sucesso. A EDT é uma técnica segura e valiosa, que pode oferecer um tratamento minimamente invasivo em casos de QI.
 

Palavras-chave

ducto torácico, linfografia, quilotórax, doenças linfáticas, radiologia intervencionista, embolização terapêutica

References

1. Chen C, Wang Z, Hao J, et al. Chylothorax after lung cancer surgery: a key factor influencing prognosis and quality of life. Ann Thorac Cardiovasc Surg. 2020;26(6):303-10. http://dx.doi.org/10.5761/atcs.ra.20-00039. PMid:32611931.

2. Pillay TG, Singh B. A review of traumatic chylothorax. Injury. 2016;47(3):545-50. http://dx.doi.org/10.1016/j.injury.2015.12.015. PMid:26776461.

3. Gilyard SN, Khaja MS, Goswami AK, Kokabi N, Saad WE, Majdalany BS. Traumatic chylothorax: Approach and outcomes. Semin Intervent Radiol. 2020;37(3):263-8. http://dx.doi.org/10.1055/s-0040-1713443. PMid:32773951.

4. Moussa AM, Maybody M, Gonzalez-Aguirre AJ, Buicko JL, Shaha AR, Santos E. Thoracic duct embolization in post-neck dissection chylous leakage: a case series of six patients and review of the literature. Cardiovasc Intervent Radiol. 2020;43(6):931-7. http://dx.doi.org/10.1007/s00270-020-02475-9. PMid:32342160.

5. Crawford D, Kim SK, Guevara CJ. Direct, percutaneous, cervical thoracic duct access under ultrasound guidance. J Vasc Interv Radiol. 2020;31(9):1499-501. http://dx.doi.org/10.1016/j.jvir.2020.04.001. PMid:32723495.

6. Zheng J, Chen YY, Zhang CY, Zhang WQ, Rao ZY. The retrospective research of enteral nutrition with medium-chain triglyceride and total parenteral nutrition support of postoperative chylothorax in adults. SAGE Open Med. 2020;8:2050312120938221. http://dx.doi.org/10.1177/2050312120938221. PMid:32655864.

7. Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg. 2002;124(3):499-502. http://dx.doi.org/10.1067/mtc.2002.124386. PMid:12202866.

8. Takuwa T, Yoshida J, Ono S, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg. 2013;146(3):571-4. http://dx.doi.org/10.1016/j.jtcvs.2013.04.015. PMid:23764409.

9. Ismail NA, Gordon J, Dunning J. The use of octreotide in the treatment of chylothorax following cardiothoracic surgery. Interact Cardiovasc Thorac Surg. 2015;20(6):848-54. http://dx.doi.org/10.1093/icvts/ivv046. PMid:25784759.

10. Tabata H, Ojima T, Nakamori M, et al. Successful treatment of chylothorax after esophagectomy using octreotide and etilefrine. Esophagus. 2016;13(3):306-10. http://dx.doi.org/10.1007/s10388-016-0526-8.

11. Ohkura Y, Ueno M, Iizuka T, Haruta S, Tanaka T, Udagawa H. New combined medical treatment with etilefrine and octreotide for chylothorax after esophagectomy: a case report and review of the literature. Medicine (Baltimore). 2015;94(49):e2214. http://dx.doi.org/10.1097/MD.0000000000002214. PMid:26656358.

12. Power R, Smyth P, Donlon NE, Nugent T, Donohoe CL, Reynolds JV. Management of chyle leaks following esophageal resection: a systematic review. Dis Esophagus. 2021;34(11):doab012. http://dx.doi.org/10.1093/dote/doab012. PMid:33723611.

13. Petrella F, Casiraghi M, Radice D, Bertolaccini L, Spaggiari L. Treatment of Chylothorax after Lung Resection: Indications, Timing, and Outcomes. Thorac Cardiovasc Surg. 2020;68(6):520-4. http://dx.doi.org/10.1055/s-0040-1710071. PMid:32492713.

14. Cope C, Salem R, Kaiser LR. Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial. J Vasc Interv Radiol. 1999;10(9):1248-54. http://dx.doi.org/10.1016/S1051-0443(99)70227-7. PMid:10527204.

15. Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol. 2012;23(5):613-6. http://dx.doi.org/10.1016/j.jvir.2012.01.078. PMid:22440590.

16. Garcia RG, Rocha RD, Franceschini J, et al. Computed tomography-guided percutaneous thoracic duct sclero-embolization for persistent chylothorax. Innovations. 2016;11(4):291-4. http://dx.doi.org/10.1097/imi.0000000000000289. PMid:27583645.

17. Souza KP, Gilberto GM, Mariotti GC, et al. Transafferent nodal embolization for lymphocele treatment: case report. Einstein. 2022;20:eRC6889. http://dx.doi.org/10.31744/einstein_journal/2022RC6889. PMid:35976354.

18. Hsu MC, Itkin M. Lymphatic anatomy. Tech Vasc Interv Radiol. 2016;19(4):247-54. http://dx.doi.org/10.1053/j.tvir.2016.10.003. PMid:27993319.

19. Jun H, Hur S, Jeong YS, Kang CH, Lee H. Thoracic duct embolization in treating postoperative chylothorax: does bail-out retrograde access improve outcomes? Eur Radiol. 2022;32(1):377-83. http://dx.doi.org/10.1007/s00330-021-08145-9. PMid:34247305.

20. Kariya S, Nakatani M, Ueno Y, et al. Transvenous retrograde thoracic ductography: initial experience with 13 consecutive cases. Cardiovasc Intervent Radiol. 2018;41(3):406-14. http://dx.doi.org/10.1007/s00270-017-1814-y. PMid:29067509.

21. Guevara CJ, Rialon KL, Ramaswamy RS, Kim SK, Darcy MD. US-guided, direct puncture retrograde thoracic duct access, lymphangiography, and embolization: feasibility and efficacy. J Vasc Interv Radiol. 2016;27(12):1890-6. http://dx.doi.org/10.1016/j.jvir.2016.06.030. PMid:27595470.

22. Koike Y, Nishimura JI, Hirai C, Moriya N, Katsumata Y. Percutaneous transvenous embolization of the thoracic duct in the treatment of chylothorax in two patients. Journal of Vascular and Interventional Radiology: JVIR. 2013;24(1):135-7. http://dx.doi.org/10.1016/j.jvir.2012.10.005. PMid:23273703.

23. Kim PH, Tsauo J, Shin JH. Lymphatic interventions for chylothorax: a systematic review and meta-analysis. J Vasc Interv Radiol. 2018;29(2):194-202.e4. http://dx.doi.org/10.1016/j.jvir.2017.10.006. PMid:29287962.
 


Submitted date:
06/27/2023

Accepted date:
08/10/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
653fd0a8a95395413f4a6d52 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections