Ultrasound-guided intranodal lipiodol lymphangiography from the groin is useful for assessment and treatment of post-esophagectomy chylothorax in three cases

Abstract

Introduction: Ultrasound-guided intranodal lipiodol lymphangiography (LAG) from the groin is a recently introduced technique for diagnosing and treating postoperative chylothorax. The benefits of this technique include reduced technical difficulty and shorter procedure duration, as compared to traditional pedal LAG. Although these benefits may eventually increase utilization of intranodal LAG, reports are still few.

Presentation of cases: Herein, we report three cases of post-esophagectomy chylothorax in whom ultrasound-guided intranodal lipiodol LAG from the groin were successfully performed with no complications. Leak points were clearly identified in the three cases. Cure was obtained in one case by the LAG only. Surgical ligations were performed after LAG in two cases and cures were achieved.

Discussion: If LAG successfully cured chylothorax, chest drain output would decrease dramatically and the leaked lipiodol could be confirmed near the leak point in plain computerized tomography (CT) in the following 1-2days. But if LAG failed to cure, chest drain output would be unchanged and the leaked lipiodol would be found diffusing in the surrounding.

Conclusion: Ultrasound-guided intranodal lipiodol LAG from the groin is a minimally invasive and easily performed procedure with high diagnostic and therapeutic value for postoperative chylothorax. If LAG failed to cure, conservative management is often insufficient and surgical ligation should be performed as soon as possible.

Keywords: Intranodal lymphangiography; Lipiodol; Postoperative chylothorax.