Bill S Majdalany1, Wael A Saad2, Jeffrey Forris Beecham Chick2, Minhaj S Khaja2, Kyle J Cooper2, Ravi N Srinivasa2. 1. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. bmajdala@med.umich.edu. 2. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Abstract
BACKGROUND: Interventional radiology treatment of chylothorax is well described in adults, with high technical and clinical success that decreases patient morbidity and mortality. However there is limited experience in children. OBJECTIVE: To report the technical and clinical success of lymphangiography, thoracic duct embolization and thoracic duct disruption in the pediatric population. MATERIALS AND METHODS: We studied 11 pediatric patients (7 boys, 4 girls; median weight 6.0 kg) who underwent lymphangiography and thoracic duct embolization from November 2015 to May 2017. All 11 (100%) children presented with chylothorax, with 1 (9%) having concomitant chylous ascites and 1 (9%) having concomitant chylopericardium. Ten (91%) children had traumatic chylothorax and one (9%) had congenital chylothorax. We recorded technical success, clinical success and complications. RESULTS: Twelve procedures were completed in 11 children. Bilateral intranodal lymphangiography was technically successful in all (100%) patients. Central lymphatics were visualized in eight (67%) procedures. Access to central lymphatics was attempted in eight procedures and successful in five (63%). In three (37%) of the eight procedures, disruption was performed when the central lymphatics could not be accessed. Clinical success was achieved in 7/11 (64%) children. Three minor complications were reported. No major complications were encountered. CONCLUSION: Lymphangiography, thoracic duct embolization and thoracic duct disruption are successful interventional strategies in children with chylothorax and should be considered as viable treatment options at any age.
BACKGROUND: Interventional radiology treatment of chylothorax is well described in adults, with high technical and clinical success that decreases patient morbidity and mortality. However there is limited experience in children. OBJECTIVE: To report the technical and clinical success of lymphangiography, thoracic duct embolization and thoracic duct disruption in the pediatric population. MATERIALS AND METHODS: We studied 11 pediatric patients (7 boys, 4 girls; median weight 6.0 kg) who underwent lymphangiography and thoracic duct embolization from November 2015 to May 2017. All 11 (100%) children presented with chylothorax, with 1 (9%) having concomitant chylous ascites and 1 (9%) having concomitant chylopericardium. Ten (91%) children had traumatic chylothorax and one (9%) had congenital chylothorax. We recorded technical success, clinical success and complications. RESULTS: Twelve procedures were completed in 11 children. Bilateral intranodal lymphangiography was technically successful in all (100%) patients. Central lymphatics were visualized in eight (67%) procedures. Access to central lymphatics was attempted in eight procedures and successful in five (63%). In three (37%) of the eight procedures, disruption was performed when the central lymphatics could not be accessed. Clinical success was achieved in 7/11 (64%) children. Three minor complications were reported. No major complications were encountered. CONCLUSION: Lymphangiography, thoracic duct embolization and thoracic duct disruption are successful interventional strategies in children with chylothorax and should be considered as viable treatment options at any age.
Authors: Bill S Majdalany; Douglas A Murrey; Baljendra S Kapoor; Thomas R Cain; Suvranu Ganguli; Michael S Kent; Fabien Maldonado; Joseph J McBride; Jeet Minocha; Stephen P Reis; Jonathan M Lorenz; Sanjeeva P Kalva Journal: J Am Coll Radiol Date: 2017-05 Impact factor: 5.532
Authors: Mohammad Reza Rajebi; Gulraiz Chaudry; Horacio M Padua; Brian Dillon; Sabri Yilmaz; Ryan W Arnold; Mary F Landrigan-Ossar; Ahmad I Alomari Journal: J Vasc Interv Radiol Date: 2011-06-29 Impact factor: 3.464
Authors: Emily H Chan; Jennifer L Russell; William G Williams; Glen S Van Arsdell; John G Coles; Brian W McCrindle Journal: Ann Thorac Surg Date: 2005-11 Impact factor: 4.330
Authors: Bill S Majdalany; Mamadou L Sanogo; Waleska M Pabon-Ramos; Kyle A Wilson; Abhishek K Goswami; Nima Kokabi; Minhaj S Khaja Journal: Semin Intervent Radiol Date: 2020-07-31 Impact factor: 1.513
Authors: Shenise N Gilyard; Minhaj S Khaja; Abhishek K Goswami; Nima Kokabi; Wael E Saad; Bill S Majdalany Journal: Semin Intervent Radiol Date: 2020-07-31 Impact factor: 1.513