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Lee, Koo, Shin, Kim, and Yang: Postoperative Chylothorax: the Use of Dynamic Magnetic Resonance Lymphangiography and Thoracic Duct Embolization
Original Article

iMRI 2018;22(3):182-186.

Published online: 12 January 2018

DOI: https://doi.org/10.13104/imri.2018.22.3.182

Postoperative Chylothorax: the Use of Dynamic Magnetic Resonance Lymphangiography and Thoracic Duct Embolization

Chae Woon Lee, Hyun Jung Koo, Ji Hoon Shin, Mi young Kim, Dong Hyun Yang

1Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea

Correspondence to: Hyun Jung Koo, M.D., Ph.D. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43 gil 88, Songpa-gu, Seoul 05505, Korea. Tel. +82-2-3010-0358 Fax. +82-2-476-0090 E-mail: radkoo@amc.seoul.kr

Received 15 June 2018       Revised 5 July 2018       Accepted 16 July 2018

Copyright © 2018 Korean Society of Magnetic Resonance in Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dynamic enhanced magnetic resonance lymphangiography can be used to provide anatomic and dynamic information for various lymphatic diseases, including thoracic duct injury, and can also help to guide the thoracic duct embolization procedure. We present a case of postoperative chylothorax demonstrated by dynamic enhanced MR lymphangiography. In this case, the chyle leakage site and location of cisterna chyli were clearly visualized by dynamic enhanced MR lymphangiography, thus allowing for management with thoracic duct embolization.

Keywords: Magnetic resonance lymphangiography, Thoracic duct injury, Chylothorax, Thoracic duct embolization

References

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Fig. 1.
Ultrasound-guided inguinal lymph node (arrowheads) selection.
imri-22-182f1.tif
Fig. 2.
MR lymphangiography for visualizing the cisterna chyli and leakage site. (a) A T2W image showing postoperative multiloculated fluid collection in the left pleural space and chest wall. (b) An enhanced 3D THRIVE image and (c, d) volume-rendered image with the enhanced 3D THRIVE sequence (20 mm thickness) showing the leakage site (arrows) and that the thoracic duct drains into left subclavian vein (arrowheads). (e) Cisterna chyli (arrowhead) was noted on the left side of the T12 level.
imri-22-182f2.tif
Fig. 3.
Conventional lymphangiography with thoracic duct embolization. (a) The cisterna chyli (arrowhead) was selected using a 2.0 Fr Progreat catheter, and Lipiodol uptake was visualized along the thoracic duct course. (b) Thoracic duct embolization was performed at the leakage site (arrow) using histoacryl glue. (c) Immediate chest radiography revealed the embolized leakage site (arrow) and thoracic duct.
imri-22-182f3.tif
Table 1.
Dynamic MR Lymphangiography Protocol
Sequence Plane TR/TE (msec/msec) Flip angle Matrix S Section thickness s ETL Approximate time, min
Fat-saturated single-shot FSE T2 W Axial thorax 650/1744 90.0 768 × 768 4 mm 79 3:00
Fat-saturated single-shot FSE T2 W Coronal thorax 650/1744 90.0 512 × 512 2 mm 79 3:00
3D GRE T1W (THRIVE) Axial thorax 1.5/3.0 15.0 528 × 528 3 mm 78 0:40 – 1:30
3D GRE T1W (THRIVE) Coronal thorax 1.5/3.0 15.0 560 × 560 2.2 mm 86 0:40 – 1:30
3D GRE T1W (THRIVE) Coronal abdomen 1.5/3.0 15.0 560 × 560 2.2 mm 86 0:40 – 1:30
Mixture of contrast material and saline 1:1, intranodal injjection in inguinal LN, hand injection (∼1 mL/min)
3D GRE T1W (THRIVE) Axial abdomen 1.5/3.0 15.0 528 × 528 3 mm 78 0:40 – 1:30
3D GRE T1W (THRIVE) Coronal abdomen 1.5/3.0 15.0 560 × 560 2.2 mm 86 0:40 – 1:30
3D GRE T1W (THRIVE), every 1–2 min until contrast leakage detected Coronal thorax 1.5/3.0 15.0 560 × 560 2.2 mm 86 0:40 – 1:30
3D GRE T1W (THRIVE), axial thorax If needed 1.5/3.0 15.0 528 × 528 3 mm 78 0:40 – 1:30
3D GRE T1W (THRIVE), if needed Axial abdomen 1.5/3.0 15.0 528 × 528 3 mm 78 0:40 – 1:30
3D GRE T1W (THRIVE) if needed Coronal abdomen 1.5/3.0 15.0 560 × 560 2.2 mm 86 0:40 – 1:30

3D = three-dimensional; ETL = echo train length; FSE = fast spin-echo; GRE = gradient echo; TE = echo time; THRIVE = T1W high-resolution isotropic volume examination; T1W = T1 weighted; TR = repetition time; T2W = T2 weighted

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