title: Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization.
abstract: OBJECTIVE
  To show the feasibility of opacifying the thoracic duct using ultrasound-guided intranodal lymphangiogram (IL) for thoracic duct embolization (TDE).
  
  
  METHODS
  Six patients (two women and four men, mean age, 59.2 y [range, 43-74 y]) underwent IL and TDE for chylothorax. Under ultrasound guidance, a needle was positioned in a groin lymph node, and lipiodol was injected. The thoracic duct was catheterized, and embolization was performed as indicated. Cumulative times from start of the procedure until initiation of the lymphangiogram, until identification of target lymphatic, until catheterization of the thoracic duct, and until completion of the procedure were collected. Times were compared with times of a control group of six patients (two women and four men, mean age, 66.7 y [range, 49-82 y]) who had undergone TDE using pedal lymphangiography (PL).
  
  
  RESULTS
  The procedure of opacification, catheterization, and embolization of the thoracic duct was successful in all cases. Cumulative times (mean ± standard deviation) in the IL and PL groups from start of the procedure until (i) initial lymphangiogram were 20.5 minutes ± 8.6 and 46.5 minutes ± 22.6, (ii) identification of a target lymphatic for catheterization were 60.5 minutes ± 18.2 and 110.5 minutes ± 31.6, (iii) catheterization of the thoracic duct were 79.0 minutes ± 28.9 and 128.2 minutes ± 37.0, and (iv) completion of procedure were 125.8 minutes ± 49.0 and 152.8 minutes ± 36.4.
  
  
  CONCLUSIONS
  IL is a feasible technique to visualize the thoracic duct for embolization. Using IL, the thoracic duct may be more quickly visualized and catheterized for TDE than with PL.
authors.affiliation: Department of Radiology, Section Interventional Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Nadolski
authors.forename: Maxim
authors.initials: M
authors.lastname: Itkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002916:Chylothorax / Q000000981:diagnostic imaging / Q000628:therapy*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D004998:Ethiodized Oil; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008220:Lymphography; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D004998:Ethiodized Oil