A Spontaneous Chyle Leak

Abstract

The typical course of the CNXII after emerging from the hypoglossal canal is medial to the internal jugular vein (IJV) and lateral to the carotid artery above the carotid bifurcation-a notably consistent relationship. 1 To our knowledge, a course of the CNXII lateral to the IJV has been reported in only 4 cases in the surgical literature. Anatomical dissection of 8 CNXIIs posterior to the internal jugular vein was published by Löwy in 1910. 2 This more exposed trajectory places the nerve at increased risk of injury and therefore is of particular interest to surgeons operating in the neck.

Intranodal lymphangiography with lipiodol as a diagnostic and therapeutic approach for spontaneous cervical chyle leak

“…In the previous two cases, chyle leak was suspected because of the presence of chyle leak through an incision. One case was treated by partial excision of the cystic chest duct, 6 and the other was treated conservatively 7 . This is the first report of spontaneous cervical chyle leak treated with intranodal lymphangiography with lipiodol alone.…”

“…The thoracic duct collects lymphatic flow from the lower extremities, abdomen, and left upper body and returns it to the venous circulation at the venous angle 8 . Cervical chyle leak usually occurs secondary to lymphatic obstruction after surgery, such as neck dissection, or trauma 6–8 . To our knowledge, there have been only two cases of spontaneous cervical chyle leak reported to date 6,7 .…”

“…Cervical chyle leak often occurs as a complication following procedures such as neck dissection or esophagectomy, due to the anatomical course of the thoracic duct 4,5 . On the contrary, spontaneous cervical chyle leak occurs without any clear cause such as surgery or trauma, and it is an extremely rare condition with very few reports 6,7 . Here, we report a case involving the successful diagnosis and treatment of cervical chyle leak by intranodal lymphangiography using lipiodol in a patient with a spontaneously occurring subcutaneous mass on the left side of the neck.…”

“…4,5 On the contrary, spontaneous cervical chyle leak occurs without any clear cause such as surgery or trauma, and it is an extremely rare condition with very few reports. 6,7 Here, we report a case involving the successful diagnosis and treatment of cervical chyle leak by intranodal lymphangiography using lipiodol in a patient with a spontaneously occurring subcutaneous mass on the left side of the neck. The patient provided written informed consent for the report of her case details and imaging studies.…”

Error in Author Name in Byline

“…In the Observation titled “A Spontaneous Chyle Leak” published online on June 10, 2021, in JAMA Otolaryngology–Head & Neck Surgery , one of the author’s names was misspelled in the byline. Where it previously read “Shane Davey,” it now correctly reads “Shane Davy.” This article was corrected online.…”