Objective: To assess lymphangiography findings and outcome of lymphatic embolisation to manage chyle leak after neck surgery. Methods: Consecutive cases of lymphangiography performed between April 2018 and May 2022 for management of chyle leaks related to neck surgery were retrospectively reviewed. Lymphangiography findings, techniques, and outcomes were analysed. Results: Eight patients (mean age: 46.5 years) were included. Six patients had undergone radical neck dissection for thyroid cancer, and two had undergone lymph node excision. Clinical presentations were: chyle drainage through Jackson Pratt catheters in 5 patients, lymphorrhea through surgical wounds in two, and enlarging lymphocele in one. Lymphangiography techniques included: inguinal lymphangiography in 4 patients, retrograde lymphangiography in 3, and transcervical lymphangiography in one. Lymphangiography revealed leaks in the terminal thoracic duct in 2 patients, bronchomediastinal trunk in 2, jugular trunk in 3, and superficial neck channels in one. Embolisation techniques included: non-selective embolisation of terminal thoracic duct (n = 2), selective embolisation of the jugular trunk (n = 3), selective embolisation of the bronchomediastinal trunk (n = 2), and intranodal glue embolisation of superficial neck channels (n = 1). One patient underwent a repeat procedure. Chyle leak resolved in all patients over a mean of 4.6 days. No complication was encountered. Conclusions: Lymphatic embolisation seems to be effective and safe in managing chyle leaks after neck surgery. Lymphangiography allowed for the categorization of chyle leaks according to their location. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct. Advances in knowledge: Lymphatic embolisation is safe and effective in managing chyle leaks after neck surgery. On lymphangiography, the location of contrast media extravasation may not be consistent. The technique for embolisation should be based on the location of the leak. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct.
INTRODUCTIONBlunt thoracic trauma is a common reason for emergency room visits. Although the use of initial routine chest computed tomography (CT) is controversial, it is increasingly used for patients with traumatic injury, and has a higher diagnostic performance than that of plain radiographs (1-5).Chest CT is useful for the evaluation of rib fractures. However, rib fractures can be missed by chest CT when there is no related change due to rib fracture and the fracture line is parallel to the CT section plane. The evaluation of ribs is particularly difficult due to their peripheral location. It is problematic for many radiologists when describing the fracture site in patients with rib fracture. Some clinicians use additional plain chest radiographs to overcome the limitations of CT in symptomatic patients; however, the patients are exposed to additional radiation during this process (6, 7). Three-dimensional reformation of the chest CT is helpful, but it takes more time for the radiologist to read the CT images (6, 8).Recently, reformatting techniques have been used in many fields of radiology. These reformatting techniques make interpreting CT images more convenient and improve diagnostic performance because they provide additional information about the lesion (6, 9, 10). The reformatted images reflect the data with iso- Purpose: To assess the value of adding a reformatted computed tomography (CT) rib series to transversely reconstructed CT imaging in the evaluation of rib fractures in patients with suspected traumatic thoracic injuries. Materials and Methods: One hundred consecutive patients with suspected traumatic thoracic injuries underwent 128-section multi-detector row CT. Transverse CT images with 5-mm-thick sections were reconstructed and rib series were reformatted using isotropic voxel data. Three independent radiologists, who were blinded to the data, interpreted the CT scans at 2 sessions with a 4-week interval between the sessions. Only transverse CT images were reviewed at the first session. At the second session, the CT images were reviewed along with the reformatted CT rib series. The following parameters were analyzed: receiver operating characteristic (ROC) curve, pairwise comparisons of ROC curves, sensitivity, specificity, positive predictive value, and negative predictive value. Results: There were 153 rib fractures in 29 patients. The level of the area under the ROC curve, Az improved for all observers. The diagnostic sensitivity and specificity of each observer tended to improve in the second session. The mean confidence scores for all observers of patients with rib fractures improved significantly in the second session. Conclusion: A reformatted CT rib series together with transverse CT scan is useful for the evaluation of rib fracture. Original ArticlepISSN 1738-2637 J Korean Soc Radiol 2013;68(1):27-
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