Enteral Administration of a Methylene Blue and 20% Lipid Emulsion Slurry to Aid in Diagnosis of Intraoperative Thoracic Duct Injury.

Thoracic duct identification during surgery in small children is often difficult or impossible secondary to patient size, surgical approach, or pathologic anatomy. Intraoperative detection of injury to the thoracic duct or other lymphatics is even more challenging, especially if the patient's anatomy is nonstandard. We describe a congenital heart disease patient with a preexisting pleural effusion that was administered an enteral slurry of methylene blue and 20% lipid emulsion intraoperatively to help delineate anatomy and detect chyle leakage. The slurry allowed for lymphatics visualization, but not thoracic duct identification.