2343. Lymphangiography and Lymphatic Interventions in Isolated Non-Traumatic Chylothorax
Authors * Denotes Presenting Author
  1. Abhishek Goswami *; Emory University School of Medicine; University of Chicago Medical Center
  2. Trevor Downing; No Affiliation
  3. Nima Kokabi; Emory University School of Medicine
  4. Anthony Depalma; Emory University School of Medicine
  5. Zachary Bercu; Emory University School of Medicine
  6. Minhajuddin Khaja; University of Michigan
  7. Bill Majdalany; Emory University School of Medicine; University of Vermont College of Medicine
Lymphangiography and thoracic duct embolization (TDE) are established treatments for traumatic chylothorax. However, there is a paucity of literature examining these techniques in nontraumatic chylothorax patients. This study investigates the presentations, techniques, and clinical outcomes of lymphangiography and lymphatic interventions in patients with non-traumatic chylothoraces stemming from various etiologies.

Materials and Methods:
A total of 23 adult patients (14 women/61%, 9 men/39%) with nontraumatic chylothorax underwent lymphangiography and associated interventions between October 2012 and October 2021. Among these patient chylothoraces, six (26%) were left-sided, eight (35%) were right-sided, and nine (39%) were bilateral. The underlying etiology was lymphoma in six (26%), idiopathic in four (17%), remote radiation in four (17%), and a variety in the remaining nine (39%). Chylothorax chronicity prior to intervention ranged from 14 days to five years. Leak volumes ranged from 1.5 L/week to 7 L/week. Lymphangiographic findings, technical approach, and clinical outcomes were recorded.

A total of 23 procedures were performed for 23 patients. Bilateral nodal lymphangiography (NL) was performed and technically successful in all (100%) patients. Interventions consisted of: NL with TDE (74%), NL alone (13%), NL with stenting (9%), and NL with lymphatic disruption (4.3%). Lymphangiography revealed a complex network of central lymphatics and/or multiple channels in 12/23 (52%), a leak and/or thoracic duct occlusion in 8/23 (35%), a dilated thoracic duct in 2/23 (9%), and nonvisualization of central lymphatics in 1/23 (4.7%). Clinical success, defined as no residual chylothorax at 28 days, was achieved in 16/23 patients (70%). Of the patients with persistent chylothorax, three (13%) had persistent chylothorax but decreased output, two (9%) passed away due to underlying illness, and two (9%) had response of chylothorax attributable to systemic therapy. There were no major or minor procedure related complications.

Lymphangiography and lymphatic interventions are useful in the treatment of nontraumatic chylothorax. Although the heterogeneity of underlying etiologies likely affects outcomes, differing lymphangiographic patterns can also likely inform clinical success.