Clinical use of lymphangiography for intractable spontaneous chylothorax.

OBJECTIVES: Aim of this study was to discuss the clinical value of lymphangiography for intractable spontaneous chylothorax.
METHODS: From 2002 to 2009, 15 cases of intractable spontaneous chylothorax underwent lymphangiography in two institutions. Patient history, imaging data, therapeutic options and follow-up were recorded and retrospectively analyzed.
RESULTS: Twelve cases had successful lymphangiography while lymphangiography failed in the other 3 cases. No procedure-related complications occurred. Lymphangiography was useful for the diagnosis of lymphatic vessel disease and underlying disease in 6 (50 %) cases, but the etiology in the remaining 6 cases (50 %) remained uncertain. Signs of leakage or contrast extravasation were directly detected in 5 (42 %) patients. Based on the lymphangiography findings, 5 cases underwent surgical intervention with satisfactory results, with one recurrence 5 years later. Two patients had steatorrhea and chyluria after successful thoracic duct ligation. Seven cases were treated conservatively, 5 of whom were cured while the other 2 cases had temporary remission of symptoms.
CONCLUSIONS: Lymphangiography can help to diagnose lymphatic vessel disease and underlying diseases, localize the leakage site for surgical therapy and prevent unnecessary surgical interventions. It may also play a role in occluding the leakage site and predicting the occurrence of adverse events due to thoracic duct ligation. We recommend lymphangiography in patients with intractable spontaneous chylothorax. © Georg Thieme Verlag KG Stuttgart · New York.