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Thoracic duct embolization (TDE) for non-traumatic chylous effusion: Experience in 34 patients.
MedLine Citation:
PMID:  22797603     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Thoracic duct embolization (TDE) is an acceptable alternative to treat traumatic chylothorax. The purpose of this study is to demonstrate efficacy of TDE to treat non-traumatic chylous effusions. METHODS: Retrospective review of 34 patients was conducted assessing technical and clinical success of TDE for non-traumatic chylous effusions. RESULTS: Thirty-four patients (mean age 59 yr, 27 female, 7 male) with non-traumatic chylous effusions underwent TDE. Presentations included 21 unilateral chylothoraces (61.8%), 9 bilateral chylothoraces (26.5%), 2 isolated chylopericardiums (5.9%), and 2 pleural effusions with chylopericardium (5.9%). TDE was technically successful in 24 of 34 patients (70.6%). Thoracic duct could not be catheterized in 4 of 34 (11.8%). Cisterna chyli was not visualized in 6 of 34 patients (17.6%), and thus TDE was not attempted. Follow up was available for 32 patients. Four lymphangiographic patterns were observed: (1) normal thoracic duct 17.6% (6/34), (2) occlusion of thoracic duct 58.8% (20/34), (3) failure to opacify thoracic duct 17.6% (6/34) and (4) extravasation of chyle 5.9% (2/34). Clinical success was varied with the lymphangiographic pattern. Clinical success rate in cases of (1) normal thoracic duct was 16% (1/6), (2) occlusion of thoracic duct was 75% (15/20), (3) failure to opacify thoracic duct was 16% (1/6), and (4) chyle extravasation was 50% (1/2). Lymphangiography alone cured 2 patients (6.5%). CONCLUSION: TDE was most successful in cases of thoracic duct occlusion and extravasation. Lymphangiography is important for identifying the cause of chylous effusions and selecting patients who benefit most from TDE.
Authors:
Gregory J Nadolski; Maxim Itkin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-10
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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