Everything Begins with an Idea

Objectives: To demonstrate the role of magnetic resonance imaging (MRI) on identifying the location of cisterna chyli and its successful percutaneous cannulation and embolization of the thoracic duct. Methods: A prospective review of 10 patients was conducted to assess the efficacy of MRI in identifying the location of cisterna chyli and its successful percutaneous cannulation and embolization of the thoracic duct leak caused by thoracic surgeries. Results: A total of 10 patients presented with chylothorax from 2016 to 2019 in two hospitals, KIMS Hospital and Aster Medcity. Treatment options of surgical thoracic duct ligation and embolization were considered in all cases. In view of recent surgery, all patients decided for percutaneous interventions. The cisterna chyli was accessed as demonstrated by the MRI using a heavily T2-weighted sequence using bony landmarks/ultrasonography guidance by a 21G China needle. After successful puncture of cisterna chyli, a 014-inch guide wire was passed and a braided microcatheter was threaded into the thoracic duct. Leak was demonstrated in seven patients while leak was not demonstrated in three patients. All underwent embolization using NBCA diluted with lipiodol injected under fluoroscopic guidance. Conclusion: MRI using a heavily T2-weighted sequence is a valuable tool in the localization of cisterna chyli in thoracic duct embolization and saves significant time during the procedure as compared to conventional nodal or pedal lymphangiography, which takes significant time for the contrast to ascend up to the level of thoracic duct.

Publication History

Article published online:
26 April 2021