Case Report: Disseminated Systemic Embolism of Lipiodol After Lymphography for Plastic Bronchitis After Fontan Repair

Abstract

Lipiodol-based lymphangiography is not only a diagnostic tool for visualization of lymphatic disorders such as plastic bronchitis (PB), but also aims a therapeutic effect by embolizing lymph leakages. We performed such percutaneous lymphatic embolization for PB in a Fontan patient with proven absence of right-to-left shunt, and demonstrated important lymphatic abnormalities in the mediastinum. Shortly after the procedure, the patient developed severe convulsive seizures, revealing multiple cerebral embolisms of Lipiodol. Radiological images were impressive, yet the clinical neurological outcome was favorable. Lipiodol-based lymphography in Fontan patients with plastic bronchitis should be avoided as this subgroup is more likely to have developed lympho-pulmonary venous connections which allow systemic emboli.

Transvenous retrograde thoracic duct embolization for effective treatment of recurrent plastic bronchitis after fontan palliation

“…When planning for such minimally invasive lymphatic procedures, it is essential to consider possible associated risks and collaborate with experienced interventional radiologists. The use of an oil‐based contrast agent in children with right‐to‐left shunting poses a risk for stroke and fatty pulmonary emboli 9,14 . Occlusion of right‐to‐left shunts has been performed to minimize that risk.…”

“…2,3 Likewise, different percutaneous TD interventions have been reported in patients with congenital heart disease and lymphatic failure (Table 1). 4,[7][8][9][10][11][12][13][14][15][16] TDE requires a comprehensive understanding of the anatomy of the TD and cisterna chyli as well as their anatomical variations. In our patient, the lymphangiogram did not identify a target central lymphatic vessel for the percutaneous transabdominal approach.…”

“…The use of an oil-based contrast agent in children with right-to-left shunting poses a risk for stroke and fatty pulmonary emboli. 9,14 Occlusion of right-to-left shunts has been performed to minimize that risk.…”