Gregory Nadolski1, Maxim Itkin. 1. Interventional Radiology Section, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Abstract
PURPOSE OF REVIEW: The aim is to inform the reader on the recent advancements in the minimally invasive treatment of chylothorax. RECENT FINDINGS: Intranodal lymphangiography has been demonstrated to be a superior alternative to traditional pedal lymphangiography for thoracic duct embolization (TDE). TDE is associated with less morbidity and better clinical success than conservative management or surgical intervention in both traumatic and nontraumatic causes of chylothorax. TDE embolization in the pediatric population was found to be feasible. SUMMARY: Recent advances in the lymphangiography techniques and the accumulation of experience in treating chylous effusions have significantly broadened the adoption of TDE to treat chylothorax. TDE for traumatic chylothorax has been demonstrated to be less morbid and more effective than surgical and conservative treatment. In cases of nontraumatic chylothorax, the patient has to be evaluated by MRI and lymphangiography to exclude causes of chylothorax which cannot be managed by interruption of the thoracic duct (e.g. lymphatic malformations or chylous ascites). Future advancements in noninvasive imaging of the thoracic duct and imaging guidance during TDE will continue to refine the percutaneous management of chylous effusions.
PURPOSE OF REVIEW: The aim is to inform the reader on the recent advancements in the minimally invasive treatment of chylothorax. RECENT FINDINGS: Intranodal lymphangiography has been demonstrated to be a superior alternative to traditional pedal lymphangiography for thoracic duct embolization (TDE). TDE is associated with less morbidity and better clinical success than conservative management or surgical intervention in both traumatic and nontraumatic causes of chylothorax. TDE embolization in the pediatric population was found to be feasible. SUMMARY: Recent advances in the lymphangiography techniques and the accumulation of experience in treating chylous effusions have significantly broadened the adoption of TDE to treat chylothorax. TDE for traumatic chylothorax has been demonstrated to be less morbid and more effective than surgical and conservative treatment. In cases of nontraumatic chylothorax, the patient has to be evaluated by MRI and lymphangiography to exclude causes of chylothorax which cannot be managed by interruption of the thoracic duct (e.g. lymphatic malformations or chylous ascites). Future advancements in noninvasive imaging of the thoracic duct and imaging guidance during TDE will continue to refine the percutaneous management of chylous effusions.
Authors: Christian A Barrera; Teresa Victoria; Fernando A Escobar; Ganesh Krishnamurthy; Christopher L Smith; Julie S Moldenhauer; David M Biko Journal: Pediatr Radiol Date: 2020-11-30
Authors: Valentin Voillet; Marcus Buggert; Chloe K Slichter; Julia D Berkson; Florian Mair; Mary M Addison; Yoav Dori; Gregory Nadolski; Maxim G Itkin; Raphael Gottardo; Michael R Betts; Martin Prlic Journal: JCI Insight Date: 2018-04-05