Treatment of a Chylous Fistula in the Neck with Thoracic Duct Embolization

Abstract

Abstract

Introduction:

Chylous fistula after lateral neck dissection for thyroid cancer is a rare but serious complication. The thoracic duct originates at the cisterna chyli (CC) and courses through the chest to the mid lateral neck before draining into the subclavian vein. If an injury and chyle leak are recognized intraoperatively, repair and drainage are performed. Effective localization and local repair can be difficult. In these patients, drainage and conservative management are recommended with a low-fat diet or parenteral nutrition. When conservative management fails, surgical clipping of the thoracic duct is classically performed. We report an alternative to surgery by percutaneous access and interventional embolization of the thoracic duct.

Materials and Methods:

A 53-year-old woman with a chylous fistula after a lateral neck dissection for thyroid cancer was treated unsuccessfully with conservative management. She was referred to interventional radiology for definitive thoracic duct embolization. Under general anesthesia, both groins were exposed. Radio-opaque contrast was injected using ultrasound guidance into a visible inguinal lymph node bilaterally. Lymphangiography identified a CC target and cannulation was performed using a 22-gauge needle under fluoroscopic guidance. The distal thoracic duct was first cannulated with a microwire after which coils and N-butyl cyanacrylate glue were used for complete embolization.

Results:

Over the next 24 hours, output stopped and the drain was removed. At 1 month follow-up, the patient had no evidence of persistent leak.

Conclusions:

Thoracic duct embolization can be a viable alternative for treatment of a chylous fistula after neck surgery. It may be considered in patients with persistent leakage after failure of conservative treatment.

No competing financial interests exist.

Runtime of video: 4 mins 51 secs