2343. Lymphangiography and Lymphatic Interventions in Isolated Non-Traumatic Chylothorax
Authors* Denotes Presenting Author
Abhishek Goswami *;
Emory University School of Medicine; University of Chicago Medical Center
Trevor Downing;
No Affiliation
Nima Kokabi;
Emory University School of Medicine
Anthony Depalma;
Emory University School of Medicine
Zachary Bercu;
Emory University School of Medicine
Minhajuddin Khaja;
University of Michigan
Bill Majdalany;
Emory University School of Medicine; University of Vermont College of Medicine
Objective:
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.
Results:
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.
Conclusion:
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.
