A 41-year-old man had been diagnosed with papillary thyroid cancer (1.6 cm) in the left thyroid lobe during his regular medical checkup. There was no past history except old pulmonary tuberculosis. Several left level 3 metastatic lymph nodes were confirmed by preoperative ultrasonography and fine-needle aspiration biopsy. The patient underwent total thyroidectomy with central compartment neck dissection and left modified radical neck dissection. On the postoperative day (POD) 1, 1170 mL was drained through the operative site drainage tube, and 1157 mL was drained on POD 2. During this time, TPN was administered. On POD 3, interventional radiology was consulted for thoracic duct embolization. After embolization, on POD 4, the amount of drainage sharply decreased to 18 mL per day, after which the patient was discharged without any problems on POD 6 (Table 1).

A 49-year-old woman had been diagnosed with papillary thyroid cancer (1.8 cm) on the thyroid isthmus by ultrasonography performed due to change in voice. There was no past history except hemorrhoidectomy. She underwent total thyroidectomy with central compartment neck dissection. On PODs 1, 2, 3, and 4, 125 mL, 101 mL, 186 mL, and 132 mL, respectively, were drained through the operative site drainage tube. During this time, TPN was administered. On POD 5, the amount of CL increased, 639 mL was drained, and we started to administer somatostatin. On PODs 6 and 7, 485 mL and 563 mL, respectively, were drained. On POD 8, the patient was referred to interventional radiology for thoracic duct embolization. After the procedure, the drainage tube was accidentally removed, but there was no swelling at the operative site after embolization. The patient started diet and was discharged without any problems on POD 10 (Table 1).

We performed thoracic duct embolization with the following technique. The patient lay on the fluoroscopy table in supine position during the procedure. A high- frequency (7-15 MHz) linear transducer (HD11XE^®; Philips Medical Solutions, Mountain View, CA, USA) was used to guide a 25-G fine needle into a lymph node located in the upper thigh (Fig. 1). Lipiodol (Guerbet, Aulnay-sous-Bois, France) was manually injected at a rate of 1 mL/min under fluoroscopic and/or C-arm computed tomography guidance (DynaCT; Siemens, Erlangen, Germany). Intranodal Lipiodol lymphangiography was performed until the Lipiodol penetrated the retroperitoneal lymphatic vessels, passed through the cisterna chyli, and finally reached the thoracic duct to reveal the leakage site. Extravasation of Lipiodol was identified at the upper thoracic level where the extravasated Lipiodol was evacuated through the operative site drain (Fig. 2). Transabdominal puncture of the cisterna chyli was performed using a 22-G needle under fluoroscopic guidance (Fig. 3). A 2.0-Fr microcatheter was co-axially advanced into the thoracic duct. A detachable coil and glue mixture (N-butyl cyanoacrylate [B. Braun Melsungen AG, Melsungen, Germany] diluted in Lipiodol at a ratio of 1:1) were used to embolize the distal thoracic duct just below the leakage site (Fig. 4). On the day after the procedure, follow-up chest X-ray was performed (Fig. 5). The study protocol was approved by the Institutional Review Board of Ajou Medical Center (AJIRB-MED- MDB-19-090). Informed consent was not obtained because of the retrospective chart review study design and use of only deidentified clinicopathological information.