title: [Transnodal ultrasound-guided lymphangiography for thoracic duct embolization in chylothorax].
abstract: BACKGROUND
  To evaluate the feasibility of ultrasound-guided transnodal lymphangiography as an modified technique for visualization of the abdomino-thoracic lymphatic system for thoracic duct embolization in patients with chylothorax after thoracic surgery.
  
  
  METHODS
  10 patients (six men and four women, mean age 53 y [range, 22-72 y]) with chylothorax after thoracic surgery underwent ultrasound-guided transnodal lymphangiography. An inguinal lymph node was accessed under ultrasound guidance with a 25-gauge spinal needle and lipiodol was injected. Opacification of the lymphatic system was intermittently controlled by fluoroscopy. The thoracic duct was percutaneously accessed and embolization was performed. Following mean times were assessed: for the procedure of inguinal puncture, number of inguinal punctures, time from start of lipiodol injection until inguinal lymphangiogram, volume of injected contrast media, duration of opacification of target lymphatics, number of percutaneous punctions and time for thoracic duct access, time for thoracic duct embolization and complications. Procedure times until initial lymphangiogram were compared with times of a control group (n=10) in patients who had undergone pedal lymphangiography.
  
  
  RESULTS
  The procedure of ultrasound guided lymph node puncture was successful in all cases (10 /10). Mean procedure times from inguinal access to initial lymphangiogram were 12.3 ± 2 minutes (pedal lymphangiography : 30.4 ± 5 minutes). Average of inguinal punctions was 1.3 (1-3). Small extravasation occurred in 4 of 10 patients. In 2 patients a contralateral inguinal punction was necessary because of lymphovenous shunts. In 10 /10 patients the lymphatic systems was opacified about 24.5 ± 9 minutes for thoracic duct embolization without required additional injection. Average of thoracic duct punctions were 1.5 (1-3). Procedure times until catheterization of the target lymphatics and until embolization of the thoracic duct were 19.3 ± 9 minutes and 14.5 ± 2 minutes respectively.
  
  
  CONCLUSIONS
  Ultrasound-guided transnodal lymphangiography is a less technically challenging technique for opacification of the abdomino-thoracal lymphatic system for subsequent thoracic duct embolization.
authors.affiliation: Radiologische Klinik, Universitätsklinikum Bonn.
authors.forename: G M
authors.initials: GM
authors.lastname: Kaschner
authors.affiliation: Radiologische Klinik, Universitätsklinikum Bonn.
authors.forename: H
authors.initials: H
authors.lastname: Strunk
mesh_terms: D000328:Adult; D000368:Aged; D002916:Chylothorax / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D004998:Ethiodized Oil; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000000981:diagnostic imaging*; D013996:Time and Motion Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D004998:Ethiodized Oil