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.