Comparative Analysis of Intranodal Lymphangiography with Percutaneous Intervention for Postsurgical Chylous Effusions.
OBJECTIVE
To evaluate clinical success and time to resolution of intranodal lymphangiography (INL) alone or with thoracic duct embolization (TDE) or thoracic duct disruption (TDD) based on initial effusion volume for postsurgical chylothorax.


METHODS
Retrospective review was performed of 57 patients (mean age 63 y; 65% male) undergoing INL alone or in conjunction with other percutaneous techniques for postsurgical chylous effusions. INL alone was performed when chylothorax output was ≤ 500 mL/d and no leak was identified during fluoroscopy.


RESULTS
INL was technically successful in all patients. There was 1 major and 2 minor complications. Clinical success rate was 71% (40/56). Clinical success rate meeting algorithmic inclusion criteria was 71.4% (5/7) for INL only, 41.7% (5/12) in INL with TDD, and 90.5% (19/21) in INL with TDE. Hazard ratio (HR) of clinical success of INL with TDE versus INL only was not statistically significant (HR 2.3, 95% confidence interval [CI], 0.70-5.87, P = .19). Median time to resolution was 14 days for INL only (95% CI, 0 days to not reached), 7 days for INL with TDD (95% CI, 4 days to not reached), and 3 days for INL with TDE (95% CI, 2 to 5 days) (P = .007). No statistically significant difference in median time to resolution existed between INL with TDE and INL only (P = .04).


CONCLUSIONS
In patients with postsurgical chylothorax, INL alone had similar rates of clinical success and time to resolution compared with INL with TDE when initial effusion volume was ≤ 500 mL/d and no leak was visualized during fluoroscopy.
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Presby East Wing, Suite E174, Pittsburgh, PA15213.
Michael
M
Yannes
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Donghoon
D
Shin
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Presby East Wing, Suite E174, Pittsburgh, PA15213.
Kevin
K
McCluskey
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Presby East Wing, Suite E174, Pittsburgh, PA15213.
Rakesh
R
Varma
Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Presby East Wing, Suite E174, Pittsburgh, PA15213. Electronic address: ernessantos@gmail.com.
Ernesto
E
Santos
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002916:Chylothorax / Q000000981:diagnostic imaging* / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D012189:Retrospective Studies; D013897:Thoracic Duct; D016896:Treatment Outcome