title: Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery.
abstract: OBJECTIVE
  This study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.
  
  
  METHODS
  Data were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5-1:20).
  
  
  RESULTS
  Clinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.
  
  
  CONCLUSIONS
  TDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.
authors.affiliation: Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan. kariyas@hirakata.kmu.ac.jp.
authors.forename: Shuji
authors.initials: S
authors.lastname: Kariya
authors.affiliation: Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Nakatani
authors.affiliation: Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Yoshida
authors.affiliation: Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komemushi
authors.affiliation: Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 5731010, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D000368:Aged; D002916:Chylothorax / Q000150:complications*; D004621:Embolization, Therapeutic / Q000379:methods*; D004998:Ethiodized Oil / Q000008:administration & dosage; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008220:Lymphography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D013897:Thoracic Duct / Q000000981:diagnostic imaging* / Q000473:pathology; D019616:Thoracic Surgical Procedures
chemical_list: D004998:Ethiodized Oil
keywords: Chylous effusion; Embolization; Leakage; Lymphangiography; Thoracic duct