Ravi N Srinivasa1, Joseph J Gemmete2, Matthew L Osher2, Anthony N Hage2, Jeffrey Forris Beecham Chick2. 1. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, MI. Electronic address: rnsriniv@med.umich.edu. 2. Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health System, Michigan Medicine, Ann Arbor, MI.
Abstract
BACKGROUND: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. METHODS: Two (66%) men and 1 (33%) woman with mean age of 52 years (range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017. Patients presented with chylous ascites (n = 3) and with renal cell carcinoma after left nephrectomy and lymph node dissection (n = 1), metastatic Merkel cell carcinoma after left nephrectomy and adrenalectomy (n = 1), and heart transplantation after failed Fontan procedure (n = 1). Pelvic lymphangiography technical successes, complications, radiation dose, contrast volume, clinical response, and follow-up were recorded. RESULTS: Pelvic lymphangiography and BORAL were technically successful in 3 (100%) patients. BORALE was attempted in 2 (66%) patients and was technically successful in both patients (100%). No minor or major complications occurred. Mean radiation dose was 1,037 mGy (range: 391-2,264 mGy). Mean contrast was 83 mL (range: 25-150 mL). Mean blood loss was 15 mL (range: 5-30 mL). Chylous ascites resolved in all 3 (100%) patients. CONCLUSIONS: BORAL and BORALE provide a rational and effective approach for the diagnosis and treatment of patients with chylous ascites and previously unidentifiable leakage site or failed lymphatic embolization.
BACKGROUND: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. METHODS: Two (66%) men and 1 (33%) woman with mean age of 52 years (range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017. Patients presented with chylous ascites (n = 3) and with renal cell carcinoma after left nephrectomy and lymph node dissection (n = 1), metastatic Merkel cell carcinoma after left nephrectomy and adrenalectomy (n = 1), and heart transplantation after failed Fontan procedure (n = 1). Pelvic lymphangiography technical successes, complications, radiation dose, contrast volume, clinical response, and follow-up were recorded. RESULTS: Pelvic lymphangiography and BORAL were technically successful in 3 (100%) patients. BORALE was attempted in 2 (66%) patients and was technically successful in both patients (100%). No minor or major complications occurred. Mean radiation dose was 1,037 mGy (range: 391-2,264 mGy). Mean contrast was 83 mL (range: 25-150 mL). Mean blood loss was 15 mL (range: 5-30 mL). Chylous ascites resolved in all 3 (100%) patients. CONCLUSIONS: BORAL and BORALE provide a rational and effective approach for the diagnosis and treatment of patients with chylous ascites and previously unidentifiable leakage site or failed lymphatic embolization.
Authors: Andrew Woerner; David S Shin; Jeffrey Forris Beecham Chick; Caitlin A Smith; Jay F Sarthy; Eric J Monroe Journal: Radiol Case Rep Date: 2020-05-19