title: Esophagectomy-related thoracic duct injury detected by lymphoscintigraphy with 99mTc-diethylenetriamine pentaacetic acid-human serum albumin: report of a case.
abstract: Chylothorax is an uncommon but potentially life-threatening complication of esophagectomy. A 72-year-old man underwent thoracoscopy-assisted subtotal esophagectomy and reconstruction with a gastric tube, through a retrosternal route, after preoperative chemoradiotherapy. Chylothorax was detected after starting enteral feeding on postoperative day (POD) 7. Despite conservative therapy such as fasting, total parenteral nutrition, and octreotide administration, massive fluid drainage continued. On POD 19, lymphoscintigraphy with (99m)Tc-diethylenetriamine pentaacetic acid-human serum albumin (HSA-D) was performed and the site of leakage was detected at the level of the fourth thoracic vertebra. On POD 23, the thoracic duct was ligated, following which the volume of chylothorax decreased. Lymphoscintigraphy 12 days after the reoperation showed no leakage from the thoracic duct. We recommend lymphoscintigraphy with (99m)Tc-HSA-D for locating the chyle leakage site and helping decide about the operative indication.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan, yasauo@med.kyushu-u.ac.jp.
authors: Yasuo
authors: Y
authors: Tsuda
authors: Masaru
authors: M
authors: Morita
authors: Hiroshi
authors: H
authors: Saeki
authors: Koji
authors: K
authors: Ando
authors: Satoshi
authors: S
authors: Ida
authors: Yasue
authors: Y
authors: Kimura
authors: Eiji
authors: E
authors: Oki
authors: Takefumi
authors: T
authors: Ohga
authors: Tetsuya
authors: T
authors: Kusumoto
authors: Koichiro
authors: K
authors: Abe
authors: Shingo
authors: S
authors: Baba
authors: Takuro
authors: T
authors: Isoda
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D061305:Lymphoscintigraphy / Q000379:methods; D008297:Male; D019275:Radiopharmaceuticals; D012086:Reoperation; D013667:Technetium; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D013897:Thoracic Duct / Q000000981:diagnostic imaging* / Q000293:injuries*; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C057162:technetium Tc 99m DTPA HSA; D013667:Technetium; D016284:Technetium Tc 99m Pentetate