Management of chyluria using percutaneous thoracic duct stenting

Abstract

Background Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. Case presentation Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion. Conclusion This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.

Thoracic Duct Occlusion Leading to Intermittent Left Supraclavicular Swelling and Pancreatitis

“…[11][12][13] Thoracic duct angioplasty and/or stenting has been used in the treatment of plastic bronchitis, recanalization of the thoracic duct to relieve chylous leaks, and to resolve ascites or variceal hemorrhage attributable to portal hypertension. [14][15][16] Although TDO may arise from a variety of conditions, the ability to make an accurate diagnosis with various lymphangiography techniques has greatly improved, though the gradients across lymphatics to suggest significance are indeterminate. 14 TDO may be categorized as physiologic from cardiopulmonary disorders or mechanical, as in this report.…”

“…Although embolization for chylothorax, chylous ascites, and lymphoceles are now well accepted, only case reports and series describe lymphatic or thoracic duct angioplasty and stenting 11–13 . Thoracic duct angioplasty and/or stenting has been used in the treatment of plastic bronchitis, recanalization of the thoracic duct to relieve chylous leaks, and to resolve ascites or variceal hemorrhage attributable to portal hypertension 14–16 …”

Occlusion of thoracic duct stent resulting in recurrent chyluria: role of renal-lymphatic fistula embolization

“…The cysterna chyli was punctured by a 21-gauge needle (Chiba, Cook company, USA) under fluoroscopy. Subsequently, a microcatheter (Progreat 2.7F, Terumo, Japan) was inserted into the TD as described in the literature [ 2 ]. When contrast was injected into the TD though microcatheter with very gentle pressure, there was no flow in the TD and the contrast material stopped at the lympho venous junction (Fig.…”

“…Recent interventional treatment method that combines embolization of renal-lymphatic fistula with TD balloon plasty or stenting have successfully treated, but only few cases have been described [ 2 , 4 , 5 ]. Aside from chyluria, impeded flow in the TD is believed to be a cause of various pathological conditions, such as chylous ascites, chylous thorax, plastic bronchitis.…”

Obstructed Thoracic Duct Stent in a Patient With Recurrence of Chyluria After Treatment

“…Recent interventional treatment method that combines embolization of renal-lymphatic stula with TD balloon plasty or stenting has proven to be effective, but only few cases have been described (Gurevich et al, 2018) (Hur et al, 2021) (Cuong et al, 2022). Aside from chyluria, impeded ow in the TD is believed to be a cause of various pathological conditions, such as chylous ascites, chylous thorax, plastic bronchitis...…”