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Lymphangiography in the Diagnosis and Localization of Various Chyle Leaks

  • Clinical Investigation
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Abstract

Purpose

Chyle leaks are rare entities infrequently encountered by most physicians. However, large centers providing advanced surgical care are inevitably confronted with chyle leaks as a complication of surgery, an extension of disease, or as a primary disorder. Regardless of the etiology, proper diagnosis and localization are paramount in the management of any chyle leak.

Materials and Methods

Here we present 16 patients with 17 chyle leaks (5 chyluria, 8 chylothorax, and 4 chylous ascites) who underwent bipedal lymphangiography (LAG) and postprocedure computed tomography (CT) imaging.

Results

In each case, the source of the chyle leak was identified and properly localized to guide further treatment. Of the 16 patients who underwent LAG and postprocedure CT imaging, the initial LAG alone provided the diagnosis and localized the chyle leak in 4 patients (25%); the postprocedure CT imaging provided the diagnosis and localized the chyle leak in 6 patients (37.5%); and the two modalities were equal in the diagnosing and localizing the chyle leak in the remaining 6 patients (37.5%)

Conclusion

These cases highlight the unparalleled abilities of LAG and the added benefit of post-LAG CT imaging in the diagnosis and fine anatomic localization of chyle leaks. In addition, these cases demonstrate the retained utility of LAG in these investigations despite the development of alternative tests involving CT, magnetic resonance imaging, and nuclear medicine imaging.

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Acknowledgments

A. Guermazi acknowledges the valuable and outstanding teaching of Marie Moutamalle. Without her patience, thousands of patients would not benefit from the diagnostic performance of lymphography.

Conflict of interest

A. Guermazi discloses the following potential conflicts of interest: (1) consultancies with MerckSerono, Facet Solutions, Genzyme, Novartis, and Stryker; (2) honoraria from Novartis; (3) stock ownership in Synarc, Inc.; and (4) grants from General Electric Healthcare. Other relations include president of Boston Imaging Core Lab, LLC.

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Authors and Affiliations

  1. Department of Medicine Transitional Year Residency Program, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

    Steve Deso

  2. Department of Radiology, Boston University Medical Center, Boston, MA, 02118, USA

    Steve Deso, Benjamin Ludwig, Nii-Kabu Kabutey, Ducksoo Kim & Ali Guermazi

  3. Department of Radiology, Saint-Louis University Hospital, 75010, Paris, France

    Ali Guermazi

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  1. Steve Deso
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  2. Benjamin Ludwig
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  3. Nii-Kabu Kabutey
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  4. Ducksoo Kim
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  5. Ali Guermazi
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Corresponding author

Correspondence to Ali Guermazi.

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Deso, S., Ludwig, B., Kabutey, NK. et al. Lymphangiography in the Diagnosis and Localization of Various Chyle Leaks. Cardiovasc Intervent Radiol 35, 117–126 (2012). https://doi.org/10.1007/s00270-010-0066-x

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  • DOI: https://doi.org/10.1007/s00270-010-0066-x

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