PURPOSE: To demonstrate the efficacy of TDE for the treatment of non-traumatic chylothorax.
METHODS: A retrospective review of 31 patients was conducted to assess technical and clinical success of the TDE for treatment of chyle effusion of non-traumatic etiology.
RESULTS: A total of 31 patients with non-traumatic chylous effusions were referred for pedal lymphangiogram and TDE . 11/31(35%) patients were presented with right, 10/31(32%) with left, 11/31(35%) with bilateral chylothorax. One patient with chylopericardium and one patient with right pleural effusion and chylopericardium. In all patients the lymphangiogram was successful. In 21/31 (67%) patients catheterization and embolization of the thoracic duct (TD) were performed successfully. In 4/31 (13%) patients catheterization failed and in 6/31 (19%) was not attempted due to non visualization of the cisterna chyli. All but two patients were available for follow up. Four lymphangiography patterns were identified: 1) occlusion of the TD (17/31), 2) normal TD (6/31), 3) failure to opacify the TD (6/31) and 4) extravasation of chyle (2/31). The clinical success in cases of occlusion of the TD was 12/17 (71%), normal TD 1/6 (16%), failure to opacify TD 1/6 (16%) and in cases of chyle extravazation 1/2(50%). Lymphangiography alone resulted in cure in 2/31 patients. There were 2 major complications: one symptomatic pulmonary artery embolization with glue and one infection of pedal lymphangiogram incision.
CONCLUSION: Pedal lymphangiography is important in identification the pathophysiology of the chylous effusions. In cases of TD occlusion TDE results in cure in 71% patients. In patients with normal TD, TDE was unsuccessful in most cases. In cases where TD cannot to be opacified, due to occlusion of the pelvic and abdominal lymphatics, other diagnostic modalities such as MRI should be considered.
CLINICAL IMPLICATIONS: We recommend lymphangiogram for all patients with non-traumatic chylous effusion to identify the path. In cases of TD occlusion we recommend TDE or TD ligation.
DISCLOSURE: Maxim Itkin, No Financial Disclosure Information; No Product/Research Disclosure Information