We present a rare case of a chylothorax in a 60-year-old patient after resection of the thymus (myasthenia gravis and thymus hyperplasia). A left-sided chylothorax developed 20 days after the resection with an estimated daily fluid loss of 1.7 l.
Chest lymphoscintigraphy was performed in the anterior and posterior position 60 min after injection of 4×74 MBq 99mTc filtered sulphur colloid subcutaneously into the first interdigital space and the retromalleolar space of both feet. The images showed abnormal tracer accumulation in the left hemithorax, as seen on the posterior chest lymphoscintigraphic image. SPECT/CT (Symbia T2 Siemens Medical) of the thorax showed abnormal mediastinal tracer accumulation between the left common carotid artery and the left subclavian artery, suggesting rupture of a collateral thoracic lymph duct. Successful ligation of a ruptured ectopic thoracic duct, situated ventral to the left subclavian artery and the phrenic nerve, by video-assisted thoracoscopic surgery was performed and achieved control of the chylothorax.
References
Bybel B, Neumann DR, Kim BY, Amin K, Rice T. Lymphoscintigraphy using 99mTc filtered sulphur colloid in chylothorax: a case report. J Nucl Med Technol. 2001;29:30–1.
Momose M, Kawakami S, Koizumi T, Yoshida K, Kanda S, Kondo R, et al. Lymphoscintigraphy using technetium-99m HSA-DTPA with SPECT/CT in chylothorax after childbirth. Radiat Med. 2008;26:508–11.
Sun SS, Tsai SC, Hsu NY, Shih CS, Lee JK, Kao CH. Preoperative and postoperative lymphoscintigraphy using Tc-99m sulfur colloid in the repair of a lymphatic leak in a patient with traumatic chylothorax. Clin Nucl Med. 2000;25:840–1.
Peterss S, Gratz KF, Khaladj N, Hagl C, Warnecke G, Fischer S, et al. Lymphoscintigraphic localization of a high-output chylus leak after bilateral lung transplantation. J Heart Lung Transplant. 2011;30:481–3
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Prevot, N., Tiffet, O., Avet, J. et al. Lymphoscintigraphy and SPECT/CT using 99mTc filtered sulphur colloid in chylothorax. Eur J Nucl Med Mol Imaging 38, 1746 (2011). https://doi.org/10.1007/s00259-011-1793-1
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DOI: https://doi.org/10.1007/s00259-011-1793-1