2:34 PM Abstract No. 214 - Image-guided intranodal lymphangiogram for chylous leaks: preliminary experience

Abstract

Purpose To demonstrate the efficacy of image-guided intranodal lymphangiography (IGIL) in the management of chylous leaks. Materials and Methods IGIL was attempted in 11 patients (six men and five women, mean age 65.4, [range, 42-83 y]) with chylous leaks. These patients were unlikely to be cured with conservative treatment, therefore they underwent IGIL. Under ultrasound guidance a groin lymph node was injected with lipiodol. Contrast progression was followed with fluoroscopy. IGIL was attempted in 8 patients (72%) with thoracic lymphatic leakage from chylothorax (six) or mediastinal chylous leaks (two). Of the eight patients, 6 of the patients had chest surgery and 2 patients had lymphoma. Within this group, 5 (62%) underwent thoracic duct disruption or embolization. Two patients were operated 2 and 3 days after IGIL and IGIL plus thoracic duct disruption, respectively (pleurodesis and thoracic duct ligation). IGIL was performed in 3 patients (28%) who developed abdominal retroperitoneal chylous leaks after nephrectomy associated with lymphadenectomy. One patient in this group had also chylothorax. No additional interventions were performed in this group. Results Technical success of IGIL was 90.9%. IGIL could not be performed in one patient with lymphoma. The amount of ethiodized oil injected ranged between 4 and 14 ml (mean volume 8 ml) and 2 patients (18.1%) underwent 2 IGIL procedures. In 7 of the 10 patients in which IGIL was possible, the site of the chylous leak was identified. No complications were observed in relation with the technique. Thoracic lymphatic leak group: One patient was demonstrated to have a pleural effusion in relation with cryptogenic cirrhosis instead a chylothorax. This patient was excluded from the secondary analysis. Both patients who underwent surgery were considered treatment failures. The chylous leak was sealed in 4 patients (57.1%). Abdominal retroperitoneal chylous leak group: IGIL was therapeutic in all 3 patients (100%). The mean length of time between IGIL and cure in both groups was 22 days (range, 1-55 days). Conclusion IGIL is an effective method in the diagnosis and treatment of lymphatic leaks and it can be used instead of traditional bi-pedal lymphangiography.