Computed tomographic lymphography of the thoracic duct by mesenteric lymph node injection.
OBJECTIVE
To document a novel technique to image the thoracic duct and its tributaries by contrast enhanced computed tomography (CT) lymphography.


METHODS
Clinical report.


METHODS
Dogs (n=6) idiopathic chylothorax.


METHODS
Ultrasonography was used to guide percutaneous injection of intestinal lymph nodes with nonionic iodinated contrast medium for preoperative CT lymphography of the thoracic duct in 6 dogs with chylothorax. Thoracic CT images were acquired immediately after contrast medium injection. All dogs had subtotal pericardectomy and thoracic duct ligation. Postoperative thoracic duct lymphography was performed in 3 dogs. Superficial cervical lymph node lymphography was performed in 2 dogs to determine cervical lymphatic contribution to thoracic effusions.


RESULTS
Preoperative thoracic duct lymphography using this technique was successful in delineating the cisterna chyli, thoracic duct, and associated lymphatic vessels in all dogs. Immediate postoperative lymphography performed in 2 dogs revealed successful duct ligation in 1 dog and persistent lymphatic leakage in the other. A 1-month postoperative thoracic duct lymphogram performed in 1 dog revealed unsuccessful ligation or recannulation of 1 of 3 redundant vessels seen preoperatively.


CONCLUSIONS
Percutaneous CT lymphography results in excellent detection of the thoracic duct and abnormal thoracic duct drainage patterns both pre- and postoperatively. The contribution of superficial cervical lymph node drainage to reoccurrence of effusions can be evaluated.


CONCLUSIONS
Percutaneous CT lymphography using ultrasound-guided contrast medium injection should be considered as an alternative to conventional open abdominal approaches to radiographic or CT lymphography.
Johnson
Eric G
EG
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA. egjohnson@ucdavis.edu
Wisner
Erik R
ER
Kyles
Andrew
A
Koehler
Carl
C
Marks
Stanley L
SL
D000818:Animals; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000601:surgery / Q000662:veterinary*; D003287:Contrast Media; D004283:Dog Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D004285:Dogs; D007267:Injections; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008220:Lymphography / Q000379:methods / Q000662:veterinary*; D008643:Mesentery; D011300:Preoperative Care; D011446:Prospective Studies; D013897:Thoracic Duct / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000662:veterinary*; D018084:Ultrasonography, Interventional / Q000379:methods / Q000662:veterinary
D003287:Contrast Media