Lymphatic Interventions for Treatment of Chylothorax

Abstract Purpose: To determine effectiveness of lymphatic interventional procedures for treatment of chylothorax. Material and methods: Analysis of interventions performed from 2001 to 2014. Results: In 21 patients with therapy resistant chylothorax a lymphatic radiological intervention was attempted, which could be performed in 19 cases: 17 thoracic duct embolizations (15 transabdominal, one transzervical and one retrograde transvenous procedure), 2 percutaneous destructions of lymphatic vessels, one CT-guided injection of ethanol next to a duplicated thoracic duct. Fourteen of seventeen (82.3 %) of the technically successful embolizations lead to clinical cure. This encluded three patients with prior unsuccessful surgical thoracic duct ligation. Also the injection of ethanol was clinically effective. Complications were a bile peritonitis requiring operation, and one clinical deterioration of unknown cause. Conclusion: Interventional lymphatic procedures allow for effective treatment in many cases of chylothorax, and should be considered early during treatment. Key points: • Thoracic duct embolization is an effective treatment method for chylothorax. • If embolization is impossible, percutaneous lymphatic destruction or injection of sclerosants/tissue adhesive next to the thoracic duct may be tried Citation Format: • Schild H, Naehle CP, Wilhelm KE et al. Lymphatic Interventions for Treatment of Chylothorax. Fortschr Röntgenstr 2015; 187: 584 – 588