Traumatic Laceration of the Cisterna Chyli Treated by Lymphangiography and Percutaneous Embolization

Abstract

Lymphangiography and percutaneous embolization has been described for the treatment of thoracic duct injury, usually occurring in the postsurgical period. We report a case of a traumatic gunshot-induced massive chylothorax. Inguinal lymphangiogram was performed demonstrating the site of injury at the cisterna chyli. The cisterna chyli was successfully accessed via a percutaneous approach, and embolization was performed. Chylothorax immediately resolved after two rounds of embolization. Although lymphangiography has been traditionally challenging and cumbersome, because of the need for pedal lymph access, the recent use of inguinal lymphangiography has made this technique more practical. Techniques used for embolization of the thoracic duct may be applied to the cisterna chyli, which is much more challenging to treat surgically.

Massive Chylothorax Following Gunshot Injury to the Left Supraclavicular Region: Case Report and Literature Review

“…We were able to achieve this because we could identify the duct at this level. At around this level it is advocated that ligation can be carried out at Poirier's triangle through a left thoracotomy [1,[21][22]. Our patient had an uneventful recovery and was subsequently discharged.…”

Bilateral Chylothorax Due to Blunt Trauma Without Radiographic Evidence of Traumatic Injury

“… 2 Percutaneous thoracic duct embolization is a safe alternative to surgical intervention and represents the first line of treatment at some institutions with reported success rates of approximately 70%. 5 , 11 However, despite having a lower morbidity rate compared to surgical intervention, it is performed in only a few centers, the reason possibly being the rarity of expertise in a technically challenging procedure. 5 , 11 …”

Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration

“…20 Most recently, traumatic lacerations of the cysterna chyli have been successfully treated using multiple embolizations. 21 At our institution, we have successfully used this technique to treat one additional patient with refractory chylous fistula following radical neck dissection. Other authors report similar success with TD injury in the neck.…”