Abstract
Our Educational Exhibit will provide up to date information on recent advancements in minimally invasive treatment of chylothorax using thoracic duct embolization. We will focus on the advantages of using ultrasound guided intranodal injection over the traditional pedal approach by detaling cases performed at our institution. Additionally, review of literature will examine why thoracic duct embolization should be a first-line therapeutic procedure for chylothorax. Thoracic duct embolization via pedal angiography has been previously described with variable clinical success rates ranging between 51-71%. The main reasons attributed to technical failure includes lack of visualization of the cisterna chili or inadequate pedal lymphatic vessels for successful cannulation. Ultrasound guided intranodal contrast injection to opacify the cisterna chyli is a promising technique to increase technical and clinical success, and has been described in several case reports and case series with favorable results. The use of ultrasound guided intranodal lymphangiography appears to be less technically challenging, less time consuming, and does not require specialized equipment that may not be available in all radiology departments. We will present 3 cases of successful thoracic duct embolization employing an intranodal lymphangiogram approach for the treatment of chylous effusions. Clinical data and details of the procedure, as well as device selection/technique will be discussed. Thoracic duct embolization via pedal angiography has been previously described with variable clinical success rates. Ultrasound guided intranodal injection to opacify the cisterna chyli is a reliatively new technique and is under represented in the literature. We hope to share our positive experience, together with review of the current literature, to show that ultrasound guided intranodal lymphangiogram approach for thoracic duct embolization is a promising technique which may increase success rate and decrease procedure time.
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