[Usefulness of Lipiodol Lymphangiography and Computed Tomography in Surgical Management of Chylothorax After Thoracic Aortic Surgery].

Chylothorax is an uncommon but clinically relevant complication following thoracic aortic surgery. Although conservative management is usually the initial approach, persistent high-output chylous effusion may require surgical intervention, for which accurate identification of the leakage site is important. We describe two cases of refractory postoperative chylothorax following aortic surgery, in which surgical management was guided by intranodal lipiodol lymphangiography combined with computed tomography (CT). The first patient developed chylothorax after descending aortic replacement via left thoracotomy for chronic Stanford type B aortic dissection. Despite fasting, total parenteral nutrition, and octreotide administration, chylous drainage persisted. Lymphatic imaging suggested a localized leak adjacent to the distal anastomosis of the descending aortic graft, and direct local ligation was performed. The second patient developed chylothorax after total aortic arch replacement for a distal arch aneurysm. Imaging demonstrated chyle leakage from the dorsal aspect of the arch graft, where local repair was considered difficult;therefore, thoracoscopic thoracic duct ligation via a right-sided approach was selected. In both cases, chylothorax resolved promptly after reoperation without recurrence. Lipiodol lymphangiography combined with CT provides valuable anatomical information for identifying the leakage site and thoracic duct course, thereby facilitating selection of an appropriate, case-specific surgical strategy in refractory postoperative chylothorax.