Thoracic Duct Embolization

Percutaneous treatment of chylothorax was developed as a minimally invasive alternative to surgical options. The treatment consists of diagnostic pedal lymphangiography followed by transabdominal catheterization of the cisterna chyli (CC)/thoracic duct (TD) and embolization of the TD proximal to the chyle leak. Initially developed by Cope et al,[1] thoracic duct embolization (TDE) has become a viable primary treatment for chylous leaks. Potential advantages include the minimally invasive nature of the procedure, which results in reduction of mortality and morbidity, as well as the ability to identify chyle leaks and variations in TD duct anatomy.[2]

SUGGESTED READINGS

• 1 Cope C, Salem R, Kaiser L R. Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial.  J Vasc Interv Radiol. 1999;  10 (9) 1248-1254
• 2 Itkin M, Kucharczuk J C, Kwak A, Trerotola S O, Kaiser L R. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients.  J Thorac Cardiovasc Surg. 2010;  139 (3) 584-589, discussion 589–590
• 3 Okuda I, Udagawa H, Takahashi J, Yamase H, Kohno T, Nakajima Y. Magnetic resonance-thoracic ductography: imaging aid for thoracic surgery and thoracic duct depiction based on embryological considerations.  Gen Thorac Cardiovasc Surg. 2009;  57 (12) 640-646
• 4 Guermazi A, Brice P, Hennequin C, Sarfati E. Lymphography: an old technique retains its usefulness.  Radiographics. 2003;  23 (6) 1541-1558, discussion 1559–1560
• 5 Plotnik A N, Foley P T, Koukounaras J, Lyon S M. How I do it: Lymphangiography.  J Med Imaging Radiat Oncol. 2010;  54 (1) 43-46
• 6 Matsumoto T, Yamagami T, Kato T et al.. The effectiveness of lymphangiography as a treatment method for various chyle leakages.  Br J Radiol. 2009;  82 (976) 286-290