Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

Liu, Dingyi; Shao, Yuan; Shi, Jianxin

doi:10.1186/1749-8090-9-8

Cited by 11 publications

(12 citation statements)

References 21 publications

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“…However, lymphangiography is invasive and requires insertion of a catheter into a lymphatic vessel and use of a contrast agent. Combining lymphangiography and CT has also been reported to be useful for detecting lymphatic vessels and abnormal communications within the pericardial space (92). Lymphoscintigraphy is a noninvasive alternative to lymphangiography, which utilizes radionuclides as imaging agents and can be performed using oral or subcutaneous administration of radiotracers (93).…”

Section: Discussionmentioning

confidence: 99%

Primary chylopericardium: A case report and literature review

Xue

Jia

et al. 2017

Exp Ther Med

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Abstract. Primary chylopericardium (CP) is a rare clinical condition in which chylous fluid containing high concentrations of triglyceride accumulates in the pericardial cavity. The present study reports a case of CP that was successfully treated by reconstruction surgery of thoracic duct. To improve the ability to diagnosis and treat this rare disease, the current study also systematically extracted 104 reported cases of primary or idiopathic CP from the past 60 years (January 1950 to December of 2015), and reviewed the clinical manifestation, etiology, diagnosis and treatment of these cases. The age at diagnosis varied between 6 weeks and 79 years with a mean age of 27.95±16.50 years. Asymptomatic patients accounted for 39.42% of cases, while the most common initial symptoms were dyspnea (44.23%) and coughing (10.58%). Jugular venous distention and distant heart sound was identified in 23 (22.12%) and 34 cases (32.69%), respectively. Cardiomegaly in X-ray scans was detected in the majority of patients (93.27%). In addition, lymphoscintigraphy and lymphangiography were helpful in identifying the source of chyle. Regarding the etiology, idiopathic cases accounted for 35.56% of the included cases in the present study. The most important cause of primary CP was abnormal connection or accumulation of lymph fluid in the pericardium (37.50%). Conservative therapy included low-fat or medium-chain triglyceride diet, as well as total parenteral nutrition. The majority of patients (71.2%) required surgery for definitive therapy, and thoracic duct ligation was the most preferred surgical procedure, performed in 44.23% of cases. Follow-up was reported in 64 cases, and all patients survived during the mean follow-up period of 12 months. Therefore, it is suggested that surgical management is the most successful treatment method and is associated with a favorable prognosis.

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Section: Discussionmentioning

confidence: 99%

Primary chylopericardium: A case report and literature review

Xue

Jia

et al. 2017

Exp Ther Med

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“…Cystoscopy, lymphangiography (LPG), computed tomography (CT), magnetic resonance imaging (MRI) and lymphoscintigraphy are used to diagnose and locate the origin of chyluria [ 2 – 4 ]. Combining LPG with post-LPG CT imaging may increase the ability to locate chyle leaks [ 2 , 5 , 6 ]., MRI is contraindicated in patients with implanted metal devices. Some patients fail conservative management because their chyle leaks are not visualized by routine contrast CT, and require additional evaluation of the lymphatic system before treatment can be started.…”

Section: Introductionmentioning

confidence: 99%

Unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography

Liu

Xia

et al. 2018

BMC Urol

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BackgroundTo identify the value of unilateral pedal lymphangiography (LPG) plus computed tomography angiography (CTA) in accurate depiction of persistent idiopathic chyluria undetectable by ordinary contrast CT.MethodsEighteen patients 44–63 years of age with persistent idiopathic chyluria who failed conservative management were included. Ordinary CT had not revealed a chyle leak. Cystoscopy, unilateral LPG, and post-LPG CT angiography (CTA) were sequentially performed. Ligation and stripping of the perirenal lymphatics were subsequently performed guided by lymphangiography and CTA.ResultsLPG and post-LPG CTA detected 17 unilateral and one bilateral chyle leaks in the 18 patients, with clear images of the communication of lymphatic vessels and the renal collecting or vascular system. The success rate was significantly better than cystoscopy (100% vs 50.0%, P = 0.005) or LPG alone (100% vs. 72.2%, P = 0.016). Chyluria resolved after surgery in all patients; no relapses were found.ConclusionsLPG plus post-LPG CTA accurately characterized perirenal lymphangiectasia that was not demonstrated by routine contrast-enhanced CT or not suitable for magnetic resonance imaging. Despite of its invasiveness, this method is a good diagnostic alternative to LPG in patients with persistent chyluria requiring surgery.

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“…Однако увеличение концентрации NGAL в моче было ассоциировано с увеличением системной жесткости сосудистой стенки, которое наблюдалось преимущественно у пациентов с тяжелой и резистентной АГ. В зарубежных исследованиях встречаются работы по изучению взаимосвязи уровня NGAL в сыворотке крови с показателями сосудистой жесткости при ОПП, однако авторы данной работы получили отрицательный результат [14]. Данных о взаимосвязи уровня NGAL с показателями сосудистой жесткости при АГ в литературе не встречалось.…”

Section: Discussionunclassified

Novel biomarkers of kidney injury and fibrosis in patients with different severity of hypertension: relation to vascular reactivity and stiffness

Mironova¹,

Iudina²,

Ionov³

et al. 2019

Russ J Cardiol

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Aim. To compare the relationships between conventional and new potentially more early investigational biomarkers (urine and ultrasound) of kidney injury and central aortic blood pressure, vascular stiffness and reactivity, endothelial dysfunction in patients with different severity of hypertension.Material and methods. Urine levels NGAL, KIM-1, L-FABP, albuminuria and serum levels of сystatin C and creatinine were measured in 92 hypertensive patients with mild and severe hypertension, 46 male (mean age 50,7±12,2 years). Glomerular filtration rate was estimated by the level of serum creatinine and cystatin C by MDRD and CKD-EPI formulas. Instrumental examination included measuring office blood pressure, 24-hour ambulatory blood pressure monitoring (SpaceLabs 90207), applanation tonometry (SphygmoCor, Artcor Medical) with the calculation of central aortic blood pressure, pulse wave velocity and augmentation index and Doppler ultrasonography with assessment of intraparenchymal renal arterial resistance indices — resistive index and pulsatility index (Vivid 7 dimension). Endothelial function was assessed by reactive hyperemia index with EndoPAT device (Itamar Medicals).Results. There were no differences in conventional levels of biomarkers between patients, however, cystatin C level increased and serum cystatin C estimated GFR and serum creatinine and cystatin C estimated GFR (CKD EPI formula) (sCr,Cys-estimated GFR) levels decreased with the severity of hypertension. These novel biomarkers were associated with increased central aortic blood pressure, arterial stiffness and intraparenchymal renal arterial resistance indices. Decreased sCr,Cys-estimated GFR levels were associated with lower reactive hyperemia index. There were no differences in NGAL, KIM-1 and L-FABP levels in patients with hypertension. However, NGAL levels were associated with increased augmentation index, resistive index in intralobular and pulsatility index in arcuate arteries, KIM-1 and L-FABP levels were associated with increased systolic and diastolic central aortic blood pressure, pulse wave velocity only in patients with severe and resistant hypertension.Conclusion. Serum cystatin C, NGAL, KIM-1 and L-FABP levels seem to be biomarkers of increased systemic and intrarenal vascular stiffness in patients with different severity of hypertension.

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Unilateral pedal lymphangiography with non-contrast computerized tomography is valuable in the location and treatment decision of idiopathic chylothorax

Cited by 11 publications

References 21 publications

Primary chylopericardium: A case report and literature review

Primary chylopericardium: A case report and literature review

Unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography

Novel biomarkers of kidney injury and fibrosis in patients with different severity of hypertension: relation to vascular reactivity and stiffness

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