Lymphoscintigraphy and SPECT/CT using 99mTc filtered sulphur colloid in chylothorax

Abstract

We present a rare case of a chylothorax in a 60-year-old patient after resection of the thymus (myasthenia gravis and thymus hyperplasia). A left-sided chylothorax developed 20 days after the resection with an estimated daily fluid loss of 1.7 l.Chest lymphoscintigraphy was performed in the anterior and posterior position 60 min after injection of 4×74 MBq 99m Tc filtered sulphur colloid subcutaneously into the first interdigital space and the retromalleolar space of both feet. The images showed abnormal tracer accumulation in the left hemithorax, as seen on the posterior chest lymphoscintigraphic image. SPECT/CT (Symbia T2 Siemens Medical) of the thorax showed abnormal mediastinal tracer accumulation between the left common carotid artery and the left subclavian artery, suggesting rupture of a collateral thoracic lymph duct. Successful ligation of a ruptured ectopic thoracic duct, situated ventral to the left subclavian artery and the phrenic nerve, by video-assisted thoracoscopic surgery was performed and achieved control of the chylothorax.This case clearly illustrates the added value of SPECT/ CT in addition to lymphoscintigraphy for the anatomical location of a traumatic rupture of a thoracic lymph duct. To our knowledge only a few case reports have been published on this subject [1][2][3][4].

Metastatic prostate cancer initially presenting as chylothorax: A case report

“…Lymphoscintigraphy, which functionally assesses the lymphatic transport and regional lymph nodes, is an easy, non-invasive method for detecting abnormalities in the lymphatic system, including leakages such as chylothorax, chyloperitoneum and chyluria. Positive findings include tracer activity at the site where lymphatic fluid is accumulated, as seen in our case (20,21). ADT is the mainstay of treatment for patients with metastatic prostate cancer.…”

Three-Dimensional Lymphoscintigraphy Using SPECT/CT and 123I-BMIPP for the Preoperative Detection of Anatomical Anomalies of the Thoracic Duct

“…13Y17 Baulieu et al 13 have reported on lymphoscintigraphy by the subcutaneous injection of 99m Tc-SC in which they could detect TD in 10 of the 30 patients with lower limb lymphedema and in 4 of the 7 patients with chylothorax and/or chyloperitoneum. There have also been a few case reports of such lymphoscintigraphy 14,15 employing SPECT/CT 16,17 for the purpose of localization of the leakage site in chylothorax. On the basis of these reports, lymphoscintigraphy by the subcutaneous injection of radiotracers seems to be useful in the localization of the leakage site in chylothorax and have a potential to visualize TD.…”

Minimal Lymphatic Leakage in an Infant With Chylothorax Detected by Lymphoscintigraphy SPECT/CT

“…Recent studies have already reported the usefulness of lymphoscintigraphy SPECT/CT for identifying the site of lymphatic leakage in adult patients with TD injuries. 18,19 Our case suggests that lymphoscintigraphy SPECT/CT is also suitable in pediatric patients presenting with chylothorax even when the amount of chyle leakage is minimal. In this neonate, the technique detected the site of lymphatic leakage, guiding the intranodal lymphangiography followed by TDE.…”