Lymphatic Interventions for Treatment of Chylothorax

 

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Abstract

Purpose: To determine effectiveness of lymphatic interventional procedures for treatment of chylothorax.

Material and methods: Analysis of interventions performed from 2001 to 2014.

Results: In 21 patients with therapy resistant chylothorax a lymphatic radiological intervention was attempted, which could be performed in 19 cases: 17 thoracic duct embolizations (15 transabdominal, one transzervical and one retrograde transvenous procedure), 2 percutaneous destructions of lymphatic vessels, one CT-guided injection of ethanol next to a duplicated thoracic duct. Fourteen of seventeen (82.3 %) of the technically successful embolizations lead to clinical cure. This encluded three patients with prior unsuccessful surgical thoracic duct ligation. Also the injection of ethanol was clinically effective. Complications were a bile peritonitis requiring operation, and one clinical deterioration of unknown cause.

Conclusion: Interventional lymphatic procedures allow for effective treatment in many cases of chylothorax, and should be considered early during treatment.

Key points:

• Thoracic duct embolization is an effective treatment method for chylothorax.

• If embolization is impossible, percutaneous lymphatic destruction or injection of sclerosants/tissue adhesive next to the thoracic duct may be tried

Citation Format:

• Schild H, Naehle CP, Wilhelm KE et al. Lymphatic Interventions for Treatment of Chylothorax. Fortschr Röntgenstr 2015; 187: 584 – 588

Zusammenfassung

Ziel: Analyse der Ergebnisse radiologisch-interventioneller Eingriffe am Lymphsystem zur Chylothorax-Behandlung.

Material und Methoden: Auswertung der seit 2001 – 2014 durchgeführten Eingriffe hinsichtlich Durchführbarkeit, Effektivität und Komplikationen.

Ergebnisse: Bei 21 Patienten mit therapieresistentem Chylothorax wurde eine interventionell-radiologische Behandlung versucht, die in 19 Fällen durchgeführt werden konnte. Vorgenommen wurden 17 Ductus thoracicus-Embolisationen (15 transabdominell, eine transzervikal, eine retrograd transvenös), 2 Lymphbahndestruktionen sowie eine CT-gesteuerte Injektion von Äthanol bei einer Ductus thoracicus-Dopplung. Vierzehn der siebzehn (82,3 %) technisch erfolgreichen Embolisationen des Ductus thoracicus führten zur Ausheilung des Chylothorax; drei dieser Patienten waren erfolglos voroperiert. Ebenfalls sistierte der Chylothorax nach der Äthanolinjektion an einen gedoppelten Ductus thoracicus-Arm. Relevante Komplikationen waren eine operationspflichtige gallige Peritonitis, sowie eine Befundverschlechterung unklarer Ursache.

Schlussfolgerung: Interventionell-radiologische Eingriffe am Lymphsystem erlauben in vielen Fällen eine effektive Chylothorax-Behandlung und sollten differenzialtherapeutisch, wenn verfügbar, stets in Erwägung gezogen werden.

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