title: Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax.
abstract: OBJECTIVE
  To identify the value of unilateral pedal lymphangiography (LAG) with non-contrast CT in the location and treatment decision of idiopathic chylothorax after failure of thoracic duct ligation.
  
  
  METHODS
  Twenty four patients aged 9-84 year old (median 44 yr) who had idiopathic chylothorax were involved, and unilateral pedal LAG with non-contrast CT was performed in every patient. All patients failed to previous right supra-diaphragmatic thoracic duct ligation.
  
  
  RESULTS
  The amount of iodized oil used was 6-14 ml with no related complications. LAG demonstrated 8 patients with thoracic duct leaks and 10 patients with leaks elsewhere, but no visible chylous leak in 6 patients. Ligation of thoracic duct was performed as the primary treatment in all 8 cases as having thoracic duct leakage and cured 7(87.5%) patients. For 8 patients not having thoracic duct lesion under LAG, the successful rate of thoracic duct ligation was 25% (2 out of 8 patients), which was significantly lower than patients due to thoracic duct lesions (P=0.02). Meanwhile, non-operative therapy had significantly higher successful rate (87.5% vs 25%, P=0.02).
  
  
  CONCLUSIONS
  Unilateral pedal LAG with non-contrast CT could identify the causes and locate the leaks of idiopathic chylothorax in 75% of patients after failure of thoracic duct ligation. Two thirds of patients were found not to have thoracic duct leakage and would be better managed by non-operative treatment.
authors.forename: Ding-Yi
authors.initials: DY
authors.lastname: Liu
authors.affiliation: Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai 200025, China. shaoyuan15@hotmail.com.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shao
authors.forename: Jian-Xin
authors.initials: JX
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002916:Chylothorax / Q000000981:diagnostic imaging* / Q000601:surgery; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult