Advertisement

IR Playbook pp 259-267 | Cite as

Lymphatic Interventions

  • Gregory J. NadolskiII
  • Maxim Itkin
Chapter

Abstract

Thoracic duct embolization (TDE) is performed to treat accumulation of lymphatic or chylous fluid in the pleural or pericardial space originating from a traumatic or non-traumatic etiology. Traumatic, often postsurgical, chylothorax can be treated by use of intranodal lymphangiography and TDE with platinum-based coils and n-butyl cyanoacrylate (n-BCA) glue with both a high degree of clinical success and low incidence of complications. As the etiology and site of leaks from non-traumatic chylothorax can vary and be difficult to identify on fluoroscopy, advanced lymphatic imaging using MR lymphangiography can guide the treatment plan as the thoracic duct or its branches may not be the sole source of the chylous leak in these instances. Lastly, early data in both children and adults has demonstrated the effectiveness of TDE to treat plastic bronchitis, a condition in which the pulmonary lymphatics have retrograde flow into the lung parenchyma resulting in the development of chyle casts in the airway. In the subsequent chapter, we will review the pathophysiology of chylothorax and plastic bronchitis as well as the imaging and treatment methods for these conditions.

Keywords

Chylothorax Plastic bronchitis Lymphangiogram Thoracic duct Embolization 

References

  1. 1.
    McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med. 2010;104(1):1–8.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Nadolski GJ, Itkin M. Thoracic duct embolization (TDE) for nontraumatic chylous effusion: experience in 34 patients. Chest. 2013;143(1):158–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Valentine VG, Raffin TA. The management of chylothorax. Chest. 1992;102(2):586–91.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Itkin M. Interventional treatment of pulmonary lymphatic anomalies. Tech Vasc Interv Radiol. 2016;19(4):299–304.CrossRefPubMedGoogle Scholar
  5. 5.
    Dori Y, Dori Y, Keller MS, Keller MS, Rychik J, Rychik J, Itkin M, Itkin M. Successful treatment of plastic bronchitis by selective lymphatic embolization in a Fontan patient. Pediatrics. 2014;134(2):e590–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Itkin MG, McCormack FX, Dori Y. Diagnosis and treatment of lymphatic plastic bronchitis in adults using advanced lymphatic imaging and percutaneous embolization. Ann AmThorac Soc. 2016;13(10):1689–96.Google Scholar
  7. 7.
    Seriff NS, Cohen ML, Samuel P, Schulster PL. Chylothorax: diagnosis by lipoprotein electrophoresis of serum and pleural fluid. Thorax. 1977;32(1):98–100.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nadolski G, Itkin M. Thoracic duct embolization for the management of chylothoraces. Curr Opin Pulm Med. 2013;19(4):1–386.Google Scholar
  9. 9.
    Stecker MS, Fan C-M. Lymphangiography for thoracic duct interventions. Tech Vasc Interv Radiol. 2016;19(4):277–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996;112(5):1361–5. discussion 1365–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Bender B, Murthy V, Chamberlain RS. The changing management of chylothorax in the modern era. Eur J Cardiothorac Surg. 2016;49(1):18–24.CrossRefPubMedGoogle Scholar
  12. 12.
    Kerlan RK, LaBerge JM. Intranodal lymphangiography: coming soon to a hospital near you. J Vasc Interv Radiol. 2012;23(5):617.CrossRefPubMedGoogle Scholar
  13. 13.
    Cope C, Salem R, Kaiser LR. Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial. J Vasc Interv Radiol. 1999;10(9):1248–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol. 2012;23(5):613–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Dori Y, Zviman MM, Itkin M, Dynamic Contrast-enhanced MR. Lymphangiography: feasibility study in swine. Radiology. 2014;273(2):410–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Krishnamurthy R, Hernandez A, Kavuk S, Annam A, Pimpalwar S. Imaging the central conducting lymphatics: initial experience with dynamic MR lymphangiography. Radiology. 2015;274(3):871–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Chen E, Itkin M. Thoracic duct embolization for chylous leaks. Semin Interv Radiol. 2011;28(1):63–74.CrossRefGoogle Scholar
  18. 18.
    Cope C, Kaiser LR. Management of unremitting chylothorax by percutaneous embolization and blockage of retroperitoneal lymphatic vessels in 42 patients. J Vasc Interv Radiol. 2002;13(11):1139–48.CrossRefPubMedGoogle Scholar
  19. 19.
    Itkin M, Kucharczuk JC, Kwak A, Trerotola SO, Kaiser LR. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg. 2010;139(3):584–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Hur S, Shin JH, Lee IJ, et al. Early experience in the management of postoperative lymphatic leakage using lipiodol lymphangiography and adjunctive glue embolization. J Vasc Interv Radiol. 2016;27:1177–86.CrossRefPubMedGoogle Scholar
  21. 21.
    Kozlov A, Itkin M, Dori Y, Nadolski G. Comparison of pedal and intranodal lymphangiography for thoracic duct embolization (TDE) of traumatic chylous leaks. J Vasc Interv Radiol. 2017;28(Suppl):S135.CrossRefGoogle Scholar
  22. 22.
    Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH. Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci. 2010;339(4):314–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Nadolski G. Nontraumatic Chylothorax: Diagnostic algorithm and treatment options. Tech Vasc Interv Radiol. 2016;19(4):286–90.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Perelman School of Medicine of the University of Pennsylvania, Diagnostic ImagingPhiladelphiaUSA

Personalised recommendations