Abstract
BackgroundManagement of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached. Further, the variation of the thoracic duct makes chylothorax difficult to treat. This report describes a rare case of chylothorax with an aberrant thoracic duct that was successfully treated using focal pleurodesis through interventional radiology (IVR).Case presentationThe patient was a 52-year-old man with chylothorax after a thoracoscopic oesophagectomy for oesophageal cancer. With conventional therapy, such as thoracostomy tube, octreotide or fibrogammin, a decrease in the amount of chyle was not achieved. Therefore, we performed lymphangiography and pleurodesis through IVR. The patient appeared to have an aberrant thoracic duct, as revealed by magnetic resonance imaging (MRI); however, after focal pleurodesis, the leak of chyle was diminished, and the patient was discharged 66 days after admission.ConclusionsChylothorax remains a difficult complication. Focal pleurodesis through IVR can be one of the options to treat chylothorax.
Highlights
Management of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached
Magnetic resonance imaging (MRI), taken on the 10th day after admission, detected two thoracic ducts; the right one ended in the thoracic cavity and was thought to be dissected, possibly at the time of operation (Fig. 2)
On the computed tomography (CT) taken after that procedure, contrast agent leaked from thoracic duct at the level of the bifurcation of the trachea to the right thoracic cavity (Fig. 3a)
Summary
Postoperative chylothorax after oesophagectomy occurs relatively infrequently, in approximately 2–9% of patients [1,2,3]. Management of postoperative chylothorax generally involves nutritional regimens as well as pharmacological and surgical therapies, but a clear consensus has yet to be reached [4]. Case presentation In November of 2017, a 52-year-old patient underwent thoracoscopic oesophagectomy and laparoscopic retrosternal gastric tube reconstruction with lymph node dissection for oesophageal cancer after neo-adjuvant therapy. Magnetic resonance imaging (MRI), taken on the 10th day after admission, detected two thoracic ducts; the right one ended in the thoracic cavity and was thought to be dissected, possibly at the time of operation (Fig. 2). Without improvement of chyle leak, on the 14th day after admission, we conducted lymphangiography through the inguinal region. On the computed tomography (CT) taken after that procedure, contrast agent leaked from thoracic duct at the level of the bifurcation of the trachea to the right thoracic cavity (Fig. 3a).
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